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* 1. Date you visited or contacted our office

Date / Time

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* 3. What was the purpose of your visit or contact?

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* 4. Program/s

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* 5. How long did you wait to be helped?

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* 6. How was your customer experience?

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* 7. Worker/s who helped you

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* 8. May we contact you?

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* 9. Your contact information (optional)

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