CSS Form
CSS Form
CSS Form
Department of Health
OFFICE OF THE SECRETARY
Health Facilities Enhancement Program - Management Office
In pursuit of service excellence, we would like to solicit your assessment on satisfaction and comments/suggestions
on the implementation of Health Facilities Enhancement Program. We will appreciate it if you can spend moment to
answer this survey form. Thank you very much!
Date: __________________________
Suggestions / recommendations:
Respondent's Profile:
Name: __________________________________________________
Office/Health Facility: ______________________________________
Complete Address: ________________________________________
Tel. No. / CP No.: ________________________________________
Email Address: __________________________________________