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use as much or as little of the form as you like
How did we do?
Please note that all fields followed by an asterisk must be filled in.
Was the operator you spoke with courteous and helpful?
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Excellent
Good
Fair
Within reason
Poor
Did we respond to your phone call in a timely manner?
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Excellent
Good
Fair
Within reason
Poor
Did we arrive within our specified time frame?
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Excellent
Good
Fair
Within Reason
Poor
What was the Quality of the work performed?
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Excellent
Good
Fair
Within Reason
Poor
Was Our Technician Neat, Courteous and Helpful?
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Excellent
Good
Fair
Within Reason
Poor
What did we work on,
and were you happy with the work?
Why were (or weren't) you happy with the work?
Were you given several options for the work to be performed?
Would you refer us to a friend or a family member?
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Yes
No
Unsure
Why would (or wouldn't) you refer us?
In your own words, is there anything we
could do to improve our level of service?
Would you like to be contacted by management regarding your service?
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Yes
No
May we publish your respones?
(without using your full name or address)
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yes
no
First Name*
First Name*
Last Name*
Last Name*
E-mail Address*
E-mail Address*
Street Address
City*
City*
Home Phone
Business Phone
Thank You
