Please answer the following questions about your experience of our performance. We appreciate your feedback, as it helps us improve our service. All information will be kept confidential.
First Name
M.I.
Last Name
Address
City
State
Zip Code
Country
E-mail Address
Phone
Bold = Required field
How would you rate the standard of service we achieved?
5
4
3
2
1
How would you rate the speed of our performance?
5
4
3
2
1
How would you describe our customer service (phone, e-mail, interpersonal interactions)?
5
4
3
2
1
How would you rate your overall level of satisfaction?
5
4
3
2
1
Would you use us again?
Yes
No
Would you recommend us to a friend or colleague?
Yes
No
Please elaborate on your opinions, and share any specific positive and negative experiences you’ve had with us.
NA
NA
NA
NA
How did you hear about our business?
How often do you require our services?
Daily
Bi-Weekly
Weekly
Bi-Monthly
Monthly
Who was your technician?
How high is your level of satisfaction with the service you received?
Very High
High
Neutral
Low
Very Low
What is your impression of our workmanship?
Very High
High
Neutral
Low
Very Low
Do you have any suggestions on how we might improve our services?

The following questions use a scale of 1 to 5, where:
• '5' equals the best rating you could give
• '3' equals a neutral rating
• '1' equals the worst rating you could give
• 'NA' means that the question is not applicable to your situation

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