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4. How Are We Doing? Please fill out this survey and submit.
6. Please Rate The Following with Excellent, Good, Average, Below Average or Prefer not to Answer.
8. Staff Member(s) was Professional
   -- Select One --ExcellentGoodAverageBelow AverageNot Applicable
9. Staff Member(s) was Knowledgeable
   -- Select One --ExcellentGoodAverageBelow AverageNot Applicable
11. Staff Member(s) Appeared Interested and Involved in His/Her Work
    -- Select One --ExcellentGoodAverageBelow AverageNot Applicable
12. Staff Member(s) Answered your Questions, Problems or Concerns
    -- Select One --ExcellentGoodAverageBelow AverageNot Applicable
14. Staff Member Treated you with Respect
    -- Select One --ExcellentGoodAverageBelow AveragePrefer not to Answer
15. Staff Member was Courteous and Attentive
    -- Select One --ExcellentGoodAverageBelow AveragePrefer not to Answer
17. Staff Member(s) Answered your Questions in a Way That You Could Understand
    -- Select One --ExcellentGoodAverageBelow AverageNot Applicable
18. Services were Provided in an Appropriate Amount of Time
    -- Select One --ExcellentGoodAverageBelow AverageNot Applicable
20. Overall Satisfaction with Services
    -- Select One --ExcellentGoodAverageBelow AverageNot Applicable
22. Please Make any Other Comments or Suggestions
24. Name of Establishment
26. Telephone Number
27. Contact Person
29. Your responses are necessary to improve our services. All responses will be kept confidential and anonymous. Thank you for completing our survey.
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34. Email address

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