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,
Ed Cooper
Transportation & Land Management Agency
 
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Date of services:

Question Title

* 1. Date of services:

Date / Time
What was the purpose of your visit or contact ?

Question Title

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

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

Question Title

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

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

Question Title

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

  1 2 3 4 5
Did you receive Timely service?
Was our staff Courteous in interacting with you?
Was our staff Knowledgeable ?
Did we Resolve your question or issue?
In order for us to improve your customer experience, Please provide your comments:

Question Title

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

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

Question Title

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

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

Question Title

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

T