How Are We Doing Date of Service Location of Service - Select -Central Regional Health Ctr. 315 S. UticaJames O. Goodwin Regional Health Ctr. 5051 S. 129th East Ave.North Regional Health and Wellness Ctr. 5635 N. Martin Luther King, Jr. Blvd.Sand Springs Health Ctr. 306 E. BroadwayBixby Health Ctr. 8120 E. 126th StreetCollinsville Health Ctr. 1201 W. CenterMingo WIC Clinic 9924 E. 21st St.South Peoria WIC Clinic 6831 S. PeoriaOther Service Received - Select -Adult health (health screenings/well women)Adult immunizationsAudiology (hearing screenings)Child Guidance (child development support/classes)Childhood immunizationsChildren First (home visiting nurse)Dental clinicEnvironmental lab (water testing, air quality, housing & nuisance abatement)Family planning (birth control, exams, pregnancy testing)Food handler classHealthy StartHuman resources (job posting, recruiting)Overseas immunizationsRestaurant inspectionsSocial work/OutreachSTD (testing/counseling for sexually transmitted diseases)Tuberculosis (TB) testingVital records (birth and death certificates)WIC (Women, Infants and Children) food vouchers, nutrition educationOther If other, please explain Comment Please read each question below and select the answer that best describes your experience. How would you rate your satisfaction with the information or services you received? Very Satisfied Satisfied Neither Satisfied nor Dissatisfied Dissatisfied Very Dissatisfied I got the information or service that I needed. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree The service or information was clear and understandable. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree The staff was friendly and polite. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree The staff was well informed. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree The staff was helpful. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Service was provided in a timely manner. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree I felt that the THD location that I visited was easy to locate. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree I felt that the THD location that I visited was well maintained. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree May we contact you? - None -YesNo Please leave your name, address, phone number or e-mail address if you want us to respond to your comments. Name Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Phone Number Email Address
