We are committed to monitoring the quality of the services and products we provide as part of an ongoing improvement process. We appreciate your feedback. All submissions are anonymous unless you require a reply to your comments.

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* 2. Date and time of service:

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* 3. Facility appearance:

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* 4. Employee/Staff attitude:

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* 5. Hours of service meet your needs?

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* 6. What is the level of satisfaction with your visit to this facility?

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* 7. If you visited a food establishment, how was the quality of food?

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* 8. Would you use our program/service again?

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* 9. Comments and/or recommendations for improvement:

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* 10. How have you benefited from this program?

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* 11. Would you like us to contact you regarding your comments?

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* 12. If question 11 is yes, please input your contact information including your name, phone number, and email address:

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