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* 1. Date of survey

Survey Date

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* 2. Please choose location.

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* 3. What was your visit for today?

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* 4. Please rate the following statements.

  Strongly disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
I got the information or service that I needed.
The service or information was clear and understandable.
The staff was friendly and polite.
The staff was well informed.
All my questions were answered.
I was served in a timely manner.

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* 5. Overall

  Very Dissatisfied Dissatisfied Neither Satisfied nor Dissatisfied Satisfied Very Satisfied
How would you rate your satisfaction with the information or services you received?

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* 6. Tell us what we can do better.

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* 7. Comment on what we did well.

This institution is an equal opportunity provider.
Esta instituciĆ³n es un proveedor que ofrece igualdad de oportunidades.

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* 8. Has a staff member exceeded your expectations?
Thank them by providing their name:

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