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Service Rating
9 - 11: Excellent / Exceed expectation
7 - 9: Good / Met expectation
5 - 7: Average / As expected
3 - 4: Needs improvement / Somewhat as expected
1 - 2: Poor / Below expectation
 
 
 
Courteous & Friendly Staff
 
10
 
9
 
8
 
7
 
6
 
5
 
4
 
3
 
2
 
1
 
 
 
Prompt & clear information
 
10
 
9
 
8
 
7
 
6
 
5
 
4
 
3
 
2
 
1
 
 
 
Staff knowledge
 
10
 
9
 
8
 
7
 
6
 
5
 
4
 
3
 
2
 
1
 
 
 
Staff Professionalism
 
10
 
9
 
8
 
7
 
6
 
5
 
4
 
3
 
2
 
1
 
 
 
Has the services met or exceed your expectation
 
10
 
9
 
8
 
7
 
6
 
5
 
4
 
3
 
2
 
1
 
 
 
How satisfied are you with our services?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Extremely Satisfied
 
 
 
Comments/Suggestions:
   
 
 
 
Name & MRN
   
 
 
 
Contact Number