Customer Satisfaction Survey

Exit Survey

What was the date of your agency contact?

What type of contact was made?

Office

Phone

Other

What Services were you looking for?

Were you treated politely?

Yes

No

Were your questions answered?

Yes

If "No" please explain

Did the agency assist you in finding services elsewhere if we could not help?

Yes

No

Overall in general how do you feel about the services provided by this agency?

Comments/Suggestions:

If you would like to be contacted about this survey, please provide your name and preferred method of contact; e.g. phone number, email, or mailing address