PHS Customer Feedback

Public Health Services (PHS) welcomes feedback about its programs, services, facilities, communications, and interactions. 

Before you begin

You may submit positive or negative feedback, a suggestion, a question, or a concern. You may submit this form anonymously. Providing feedback will not affect your eligibility for or access to PHS services. Please do not include Social Security numbers, medical record numbers, or other sensitive personal information.

Which PHS program, clinic, service, or location is your feedback about? *

 

Date of experience, if applicable. (DD/MM/YY)

 

If you would like to submit you feedback without providing your contact information, please leave Name, Email, and Phone blank. 

 
 
 
*

Please describe what happened, what worked well, what could be improved, and/or what assistance you need. *

I understand that my feedback may be shared with the appropriate County staff to review and address my submission. I understand that providing contact information is optional and that PHS may be unable to respond to anonymous feedback.

Submitted by (please select one) *

 

 

 Customer
 Authorized Representative
 Staff member on customer's behalf

Preferred language or communication support. 

 Phone
 Email
 No follow-up requested

For an immediate emergency, call 911. Requests for language assistance, reasonable accommodation, privacy review, civil-rights review, or other specialized support may be routed to the appropriate County process.