1. Was everything about the process explained to you clearly?

2. Were there other referrals made to you in addition to the service you were initially seeking?

3. Was the representative courteous?

4. Did the representative present their business card?

5. Were you able to understand the information given to you?

6. How long was your service time (including wait time and interview)?

7. At the time of the interview, did you have a clear understanding of the Rights & Responsibilities?

8. On a scale of 1-10 (10 being the best) how would you rate your experience at our office today?

9. How many visits have you made to this office within the past 30 days?

10. Please give us a few suggestions on what you would like to see with our services.

T