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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:

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Loretta V. Davis, MSA
Director/Health Officer

Barbara Harris-Ellis, RN, MPA
Deputy Health Officer

Jody A. Connally
Director of Administration

Talat Danish, MD, MPH, FAAP
Medical Director

Mary Mazur
Director of Communications

Catharine Oliver, RN, MSN
Community and Maternal Health Services Manager

Candice E. Jemison, BSN, RN
Department Manager, Disease Control

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Wayne County Central Administrative Offices - 500 Griswold St. - Detroit, MI 48226

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