CUSTOMER SATISFACTION SURVEY

Thank you for helping us serve you better!

Federal Occupational Health values your feedback about how well we are doing our job and what we can do to improve the services we deliver to you. Please take a few moments to evaluate our services by answering the questions below. Then electronically submit your answers by pressing the button at the end of the survey.

Occupational Health Center

* Please enter the 3 digit site code for the site that provided your service. If you do not have this code, please contact your Occupational Health Center for that information. Example: (Z99)

* Please enter the date your Occupational Health Center provided your service: (mm/dd/yyyy)

Agency

* Please select your employing agency:

Service

* Purpose of Visit

Rating

Using a scale of 1 to 5 (1=POOR and 5=EXCELLENT, N/A=NOT APPLICABLE), please rate each of the following regarding services you received today:

1. Flexibility in scheduling an appointment

2. Prompt attention upon arrival

3. Courteousness of staff

4. Explanation of procedure

5. Thoroughness of service

6. Privacy/confidentiality of environment

7. Explanation of results/answers to your questions

8. Clarity on follow-up actions to take

9. Helpfulness of educational /informational brochures

10. Overall quality of our services

Did we respond to your request for an appointment/service within 24 hours?

Yes

No

N/A

What additional programs/services would you like to see FOH offer?

What other suggestions do you have about how we might serve you better?

If you would like to speak with a member of the FOH Management Team regarding your experience, please provide us with your name and phone number or e-mail address:

Please press the submit button to submit your answers.

* Indicates Response Required