* 1. What is the approximate date of your visit/service?


* 3. What is the name(s) of the staff who assisted you?

* 4. How were you assisted?

* 5. Overall, how would you rate the quality of your customer service experience?

* 6. How well did we understand your questions and concerns?

* 7. How much time did it take us to address your questions and concerns?

* 8. How knowledgeable did our customer service representative seem to you?

* 9. Do you have any suggestions for improving our services?

* 10. If you would like a follow-up response, please complete this section.