Customer Feedback Form Name: Address: Tel. No.: Email: Date: Service Availed: Purpose of Transaction: Person/Unit/Office Transacted With: Part I. Customer Satisfaction Rating Rating scale: 1–Poor | 2–Fair | 3–Satisfactory | 4–Very Satisfactory | 5–Outstanding | Questions 1 2 3 4 5 1. How would you rate your OVERALL SATISFACTION with regard to the quality of service delivery? 1 2 3 4 5 2. How satisfied were you in terms of the response time to your transaction given by the office? 1 2 3 4 5 3. How satisfied were you with the outcome of the service provided? 1 2 3 4 5 4. How satisfied were you with the service provider’s information/understanding of the service being provided? 1 2 3 4 5 5. How satisfied were you with the service provider’s competence or skill? 1 2 3 4 5 6. How satisfied were you with the provider’s friendliness, fairness, and willingness to do more than expected? 1 2 3 4 5 Part II. Customer Feedback 1. Please check if you are providing a compliment, suggestion, or complaint: ComplimentSuggestionComplaint 2. Recommendation/Suggestion/Desired Action from the Office:
