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Dear Customer:



As the manager of [COMPANY], I want to thank you for giving us the opportunity to serve you. Please help us serve you better by taking a couple of minutes to tell us about the service that you have received so far. We appreciate your business and want to make sure we meet your expectations. Attached, you will find a coupon good for ...... We hope that you will accept this as a token of our good will.



Sincerely,

[MANAGER_NAME]

Manager
 
 
 
In evaluating your most recent customer service experience, was the quality of service you received:
 
Very poor
 
Somewhat unsatisfactory
 
About average
 
Very satisfactory
 
Superior
 
 
 
Please describe if there was any particular aspect of the service experience that stood out:
   
 
 
 
Please describe if there was any particular aspect of the process that stood out:
   
 
 
Customer Service Representative
The customer service representative as very courteous.
 
Strongly disagree
 
Somewhat disagree
 
Neutral
 
Somewhat agree
 
Strongly agree
 
 
 
Which of the following qualities of the service representative stood out (as being superior)?
 
Patient
 
Enthusiastic
 
Listened carefully
 
Friendly
 
Responsive
 
Other
 
 
 
What qualities of the customer service representative irked you?
 
Not patient
 
Not enthusiastic
 
Didn't listen carefully
 
Unfriendly
 
Unresponsive
 
Other
 
No qualities irked me
 
 
 
On avarage, how often do you visit our Clinic?
 
Once per week
 
Once per fortnight
 
Once per month
 
Once per quarter
 
Once per 6 months
 
Once per year
 
 
 
Comments/Suggestions:
   
 
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