TLMA

How Are We Doing?

Dear Customer,

We value your input as we work to provide an excellent customer experience. Thank you for taking the time to assist us in reaching that goal by providing your feedback.

Thank you,

Charissa Leach

Transportation & Land Management Agency

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* 1. Date of services:

Date / Time

Date

Time

AM/PM

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* 2. County Floor of Service:

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

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* 4. How do you rate your overall experience ? (check one)

Poor

Fair

Good

Very Good

Excellent

Poor

Fair

Good

Very Good

Excellent

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* 5. On scale of 1 To 5 ( 1=Poor, 5=Excellent), Please rate your experience:

	1	2	3	4	5
Did you receive Timely service?	Did you receive Timely service? 1	Did you receive Timely service? 2	Did you receive Timely service? 3	Did you receive Timely service? 4	Did you receive Timely service? 5
Was our staff Courteous in interacting with you?	Was our staff Courteous in interacting with you? 1	Was our staff Courteous in interacting with you? 2	Was our staff Courteous in interacting with you? 3	Was our staff Courteous in interacting with you? 4	Was our staff Courteous in interacting with you? 5
Was our staff Knowledgeable ?	Was our staff Knowledgeable ? 1	Was our staff Knowledgeable ? 2	Was our staff Knowledgeable ? 3	Was our staff Knowledgeable ? 4	Was our staff Knowledgeable ? 5
Did we Resolve your question or issue?	Did we Resolve your question or issue? 1	Did we Resolve your question or issue? 2	Did we Resolve your question or issue? 3	Did we Resolve your question or issue? 4	Did we Resolve your question or issue? 5

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* 6. In order for us to improve your customer experience, Please provide your comments:

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* 7. Would you like us to contact you as a follow up to your experience?

Yes

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* 8. If you would like us to contact you please provide your information:

Name:

Phone:

E-mail: