Form Center

2. We appreciate your feedback on your visit with the McLean County Health Department.
4. 1. On what date did you visit us?
   1. On what date did you visit us?

   1. On what date did you visit us?
6. 2. Were you happy with the service or care received?

   1. Yes
   2. No
8. 3. Were you treated kindly during your visit?

   1. Yes
   2. No
10. 4. Were you provided service within a reasonable amount of time?

    1. Yes
    2. No
12. 5. Were all your questions answered?

    1. Yes
    2. No
14. 6. Would you recommend our services to others?

    1. Yes
    2. No
16. 7. Which area(s) did you visit?

    1. Dental
    2. Immunizations
    3. WIC
    4. Family Case Management

    1. Environmental Health
    2. Communicable Disease
    3. Administration
18. Additional comments/suggestions:
20. Thank you!
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field