We would like to know how you feel about the services we provide so we can make sure we are meeting your needs.  Your responses are directly responsible for improving our services.  All responses will be kept private.  Thank you for your time.
Today's Date: 
At which clinic were you seen?
Taylor Health Center Wayne Health Center Dearborn WIC
Western Wayne WIC Hamtramck Sumpter
Other: 
1. From which program(s) did you receive services?
STD HIV WIC
Dental Family Planning     Immunizations
Other: 
2. Did you schedule an appointment or did you walk-in?
  Appointment Walk-in
3. The time I waited to receive assistance was reasonable.
Strongly Disagree Strongly Agree
1 2 3 4 5
4. The office hours were reasonable.
Strongly Disagree Strongly Agree
1 2 3 4 5
5. Staff was professional and kind while assisting me.
Strongly Disagree Strongly Agree
1 2 3 4 5
6. Staff was well informed.
Strongly Disagree Strongly Agree
1 2 3 4 5
7. Staff answered all of my questions.
Strongly Disagree Strongly Agree
1 2 3 4 5
8. I received materials that were well written and understandable.
Strongly Disagree Strongly Agree
1 2 3 4 5
9. The facility was neat and clean.
Strongly Disagree Strongly Agree
1 2 3 4 5
10. I would rate my overall satisfaction as:
Strongly Dissatisfied Strongly Satisfied
1 2 3 4 5
Additional Comments: