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2. Date of visit:
3. Department visited:
5. Employee(s) with whom you had contact:
7. Purpose of visit:
9. RATINGS
11. Promptness of service

    1. Excellent
    2. Good
    3. Fair
    4. Poor
13. Courtesy of employees

    1. Excellent
    2. Good
    3. Fair
    4. Poor
15. Knowledge of employees

    1. Excellent
    2. Good
    3. Fair
    4. Poor
17. Employees' ability to resolve problems

    1. Excellent
    2. Good
    3. Fair
    4. Poor
19. COMMENTS:
21. Name (optional):
23. Phone (optional):
24. Cell phone (optional):
26. Email (optional):
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28. 1. Receive an email copy of this form.
29. Email address

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30. Submit Submit and Print

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