Assessor - Customer Satisfaction Survey

Items marked with (*) are mandatory.

1. Name of employee who assisted you:

(a). Purpose Of Visit:*

Please select/enter your purpose of visit.

2. How promptly did we serve you? *

1* - Poor 2* - Fair 3* - Good 4* - Very Good 5* - Excellent

Please provide rating.

3. How satisfied were you with your overall treatment? *

1* - Very Dissatisfied 2* - Dissatisfied 3* - Fair 4* - Satisfied 5* - Very Satisfied

Please provide rating.

4. How knowledgeable and professional were we? *

1* - Poor 2* - Fair 3* - Good 4* - Very Good 5* - Excellent

Please provide rating.

5. How courteous and helpful were we? *

1* - Poor 2* - Fair 3* - Good 4* - Very Good 5* - Excellent

Please provide rating.

6. Was your contact with our staff successfully concluded?

Yes

Other(Please Specify)

7. Comments on the service received:

8. Would you like someone from our office to contact you regarding the service you received?

Yes

9. Contact Information (Optional):

Survey Not Available