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Customer Feedback Form
 

 

 
Fields marked with a * must be filled in
Description of service received:
Employee Name(s) or Division
   
1. I was treated courteously
Agree Somewhat Agree
      and professionally:*
 Disagree Somewhat Disagree
2. Service was provided in Agree Somewhat Agree
      a timely manner:* Disagree Somewhat Disagree
3. My questions were answered       and/or my problem was solved:*
 Agree Somewhat Agree
Disagree Somewhat Disagree
4. If problem not solved, I was Agree Somewhat Agree
       told of other options:* Disagree Somewhat Disagree
5. Overall I would rate the Excellent Fair
      service I received as:* Good Poor
6. Method of Contact: * Phone In Person
Check all that apply Letter Other
  Email  
Comments:
* Name:
*Address:
City: State: Zip:
Email: Telephone:
Fields marked with a * must be filled in
 

The above information will help us notify employees and their supervisors.
We may contact you if additional information is needed.

 

 
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