Please let us know how we are doing by taking a few moments to fill out this form.
Please check services provided.
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| Food |
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| Housing |
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| Water |
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| Toxics |
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| Other |
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| Please rate the following:
Response Time |
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| Courtesy of Staff |
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| Knowledge of staff |
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| Helpfulness of information: Written |
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| Verbal |
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| Staff Availability |
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| Information about the process |
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| Appropriate follow-up |
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| Overall Satisfaction with the service |
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| If you answered FAIR or POOR
to any of the previous questions,
please tell us what was unsatisfactory about the service: |
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| Please give us your comments and suggestions to improve our service: |
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| If you would like to recognize an employee who provided excellent service, please indicate his/her name and how he/she assisted you:
Please enter the following information (optional) |
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| *Name |
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| **Telephone (include area code) |
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| *E-Mail Address |
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| FAX |
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