Customer Service Survey

What type of appointment did you have today*

How long were you in the waiting room?*

Where you greeted in a courteous professional manner when entering your appointment*

After leaving the waiting room, How long was your appointment.*

Were you found eligible for our services?*

Did the Service Officer explain the requirements for the services requested*

Were you made aware of other services provided by our agency?*

Were you made aware of services available in the community.*

Please list all comments or recommendations.

Optional Information

The following Information is recommended, but not required. All information provided is confidential and used for improvements in our services

Your Name (optional)

First Last

Date of appointment (optional)

If we have further questions, and would like us to contact you by email, please enter it here (optional)

If we have further questions and would like us to to contact you by phone, please enter it here (optional)

Benefits Advisor that assisted you (Optional)