Your Opinion Matters!

Important note before completing the survey: under Florida law your survey response is considered public record. Any information you provide could be released in response to a public records request. If you would like to speak with someone about your customer service instead, please contact our Community Health & Performance Management Division at 727-824-6900 x4582. Para la encuesta en Español,por favor haga clic aquí: clic aqui

1. Please tell us the name of the EMPLOYEE who provided excellent service today! (If you can't provide a name, please enter NA).

2. Please provide the date that you received service.

Date:
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3. Please select service(s) received:

5. Please rate your overall satisfaction with the service received.

6. Please rate your level of agreement with the following statements:

  Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree
a. I received the information or service that I needed.
b. I was served in a timely manner.
c. I was treated with courtesy and respect.
d. Staff was friendly and polite.

7. Comments: If you would like to provide additional comments, please provide information in the space below:

If you were not satisfied with your service and you would like to speak to someone, please call our Community Health & Performance Management Division at: 727-824-6900 ext. 4582

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