* 1. What was the main service you received from us?

* 2. I was treated with courtesy and respect by the staff who helped me today.

* 3. I felt the quality of service was excellent.

* 4. Services were completed in a timely and efficient manner.

* 5. I would recommend services to others.

* 6. I learned of this service from...

* 7. Date of Service and Name of Person Assisting me Today: