Customer Satisfaction Survey Question Title * 1. Date Services Provided On: Date Question Title * 2. Service Provided: Question Title * 3. What employee and/or department assisted you today? Question Title * 4. Please rate the employee's attitude: Poor Fair Good Excellent n/a Question Title * 5. Please rate our promptness of service: Poor Fair Good Excellent n/a Question Title * 6. Please rate the quality of service you received: Poor Fair Good Excellent n/a Question Title * 7. Were your questions answered sufficiently? Yes No n/a If not, please explain. Question Title * 8. Was the employee's knowledge sufficient? Yes No n/a If not, please explain. Question Title * 9. Comments or Suggestions? Question Title * 10. If you would like to be contacted, please provide your information below. Name: Phone: Email: Submit response