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* 1. Are you a:

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* 2. How knowledgeable did the staff member seem to you?

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* 3. How clear was the verbal information the staff member provided to you?

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* 4. How clear was the written information the staff member provided to you?

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* 5. How helpful was the staff member at assisting you in achieving compliance?

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* 6. In what areas could the staff member improve?

  Yes No
Professionalism
Courteous
Listening to your concerns
Communication

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* 7. Please provide additional comments and/or suggestions to help improve our services.

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* 8. Would you like to be contacted by a supervisor? If so, please add your name and phone number.

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