Date: *
Name:*
Company/Ministry *
Address
Phone Number"
Email Address:
Please answer the folling questions:
What is the name of the person who assisted you?
What did you need assistance
for?
What location did you receive the
assistance? Sixth
Mount Zion Baptist Temple Six
House Other <\SELECT>
Pease rate your experience: 1=Very Poor 2=Poor
3=Average 4=Good 5=Excellent
1) I was greeted in a friendly manner. 1 2 3 4
5 <\SELECT>
2) I felt welcomed. 1 2
3 4 5 <\SELECT>
3) I received prompt attention to my needs. 1
2 3 4 5 <\SELECT>
4) The office atmosphere was professional. 1 2 3 4
5 <\SELECT>
5) I was asked pertinent questions to help get my matter resolved. 1 2 3
4 5
<\SELECT>
6) My matter was resolved in a timely fashion. 1
2 3 4 5
<\SELECT>
7) I would come to this establishment again for my needs. 1
2 3 4 5
<\SELECT>
8) I would recommend doing business with this establishment to my associates.
1 2 3
4 5
<\SELECT>
9) I received a callback within 24 hours of my original inquiry (if
required). 1 2 3 4 5
<\SELECT>
10) The quality of work was acceptable. 1 2 3 4
5 <\SELECT>
11) Can a representative call you back to follow up? Yes
No <\SELECT>
Additional Comments
