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  1. Surveys
  2. 2010
  3. March
  4. G
  5. General Customer Service
0%
Exit Survey »
 
 
 
 
Walk-In
 
Appointment
 
Home Visit
 
Other
 
 
 
Date
Time of visit
 
 
 
If you would like to provide specific details on your visit, please do so below. Your comments are valued.
   
 
 
 
Was it difficult to reach us by phone, make an appointment or apply for service?
 
No
 
Yes

 
 
 
If yes, please explain:
   
 
 
 
How long did you have to wait for service?
 
No waiting time
 
Under 15 minutes
 
15-30 minutes
 
over 30 minutes
 
 
 
Were you referred to the right program for assistance?
 
Yes
 
No
 
 
 
Did you receive the service you requested?
 
Yes
 
No, I wasn't eligible
 
 
 
No, for other reasons - please explain:
   
 
 
How would you rate our service?
Excellent Good Average Below Average Poor
Respectfulness of staff
Sensitivity of staff
Staff listened to your concerns
Staff provided needed information
Staff responded to your needs
Overall quality of service
 
 
 
How can we improve?
   
 
 
 
Would you like to share more information with us? If yes, please provide your information and our staff will contact you.
   
 
 
 
Additional comments:
   
 
 
Internal Information
Date & Time
Employee Name
Program Department
Referred From
Program Department
 
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