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2. First Name
4. Last Name
6. Phone Number
8. Date of Visit
   Date of Visit
10. Who assisted you today?
12. Were you greeted upon entry to the Clerk's Office?*

    1. yes
    2. no
14. When handling my transaction, the Deputy Clerk was courteous and professional?*

    1. Very satisfied
    2. Satisfied
    3. Neither satisfied nor dissatisfied
    4. Dissatisfied
    5. Very dissatisfied
16. When handling my transaction, the Deputy Clerk was knowledgable?*

    1. Very satisified
    2. Satistifed
    3. Neither satisfied nor dissastisfied
    4. Dissatisfied
    5. Very dissatisfied
18. When handling my transaction, the Deputy Clerk provided relevant information?*

    1. Very satisfied
    2. Satisfied
    3. Neither satisfied nor dissastified
    4. Dissastified
    5. Very dissatisfied
20. When handling my transaction, the Deputy Clerk was able to resolve my issue or satisfy my inquiry?*

    1. Very satisfied
    2. Satisfied
    3. Neither satisfied nor dissatisfied
    4. Very dissatisfied
22. My overall service was*

    1. Excellent
    2. Very good
    3. Good
    4. Fair
    5. Poor
24. Do you recommend this employee for and Office Award?

    1. yes
    2. no
26. Additional Comments
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field