County Member Experience

Please tell us about your last customer service experience with your county department of human/social services or eligibility site. This survey will take around 10-12 minutes to complete.

You do not need to identify yourself to complete the survey; if you do, we may contact you for more information. We will use this information to improve the customer service experience. This information will not impact your eligibility or benefits.

If you have a specific complaint about your county or eligibility site, you can also use our County and Eligibility Site Complaint Form. Any information you provide will be treated as confidential.

Only email addresses connected with Health First Colorado PEAK accounts will be eligible for a gift card. If you need help finding the email address on your account, or if you need to update it, you can update it in one of these ways:

  1. Visit Colorado.gov/PEAK. In PEAK, go to your ‘Mailbox’ and select ‘Update communication preferences’ from that page. 
  2. Use the Health First Colorado app on your phone. This free app is for Health First Colorado and CHP+ members.
  3. CHP+ members can call 800-359-1991 (State Relay: 711)
  4. Contact your county department of human services. 
Sign in to Google to save your progress. Learn more
Name (optional)
Email 

 *
Please enter the email you use on your Health First Colorado PEAK account.
Phone (optional)
What county or eligibility site did you get services from? (eligibility sites are at the end of the list) *
How long ago was your most recent customer service experience with your county department of human/social services or eligibility site? *
How did you contact your county department of human/social services or eligibility site during your most recent customer service experience? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of State.co.us Executive Branch. Report Abuse
Google Forms