Client Feedback Form
Client Feedback Form Control.:_________
Your Experience matters to us!
I. Client Information
Name(Optional): _____________________________ Date Visited:________________
Office Visited: ____________________________ Phone No. (Optional): ________________
Purpose of Visit(Please spicify):________________________________________________________
Time Started:_________________ Time Finished:________________
II. Client Satisfaction Rating
Kindly rate the quality of service provided by checking(ü) the appropriate box.
Very Dissatisfied Dissatisfied Neutral Satisfied Very Satisfied
1. PHYSICAL The
environment is clean and orderly
2. SERVICES Your
concern was addressed promptly
and appropriately
3. PERSONNEL The
employee was courteous and
accommodating
* OVERALL RATING FOR
THE SERVICE PROVIDED:
How satisfied are you with
the quality of services provided?
III. Suggestions/ Complements/Comments.
Thank you for your valuable input to help us continuously improve our services!
Privacy Notice:
The personal Information included in this document should only be used for the purposes of administering the survey,
Any personal information included herein may not be used for other perposes aside from those stated above