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Personal Information
Name
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First
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Date of purchase/service:
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Email
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Phone Number
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Who performed your service?:
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Which location are you rating?:
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Location 1
Location 2
Location 3
Location 4
Location 5
Where did you hear about us?:
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Newspaper
Television
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Family / Friend *
Other *
Name of Family / Friend OR Other
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Rate our service in each of the following areas.
★
☆☆☆☆
1 is poor; 5 is excellent
★★★★
★
Our Store
Appearance: overall clean & presentable?
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1 ★☆☆☆☆ Poor
2 ★★☆☆☆
3 ★★★☆☆
4 ★★★★☆
5 ★★★★★ Excellent
Waiting Area: clean & comfortable?
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1 ★☆☆☆☆ Poor
2 ★★☆☆☆
3 ★★★☆☆
4 ★★★★☆
5 ★★★★★ Excellent
Store Hours: Were they convenient?:
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1 ★☆☆☆☆ Poor
2 ★★☆☆☆ Below Average
3 ★★★☆☆ Average
4 ★★★★☆ Above Average
5 ★★★★★ Excellent
Our Employees
Helpful: Was it easy to get help when you needed it?:
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1 ★☆☆☆☆ Poor
2 ★★☆☆☆
3 ★★★☆☆
4 ★★★★☆
5 ★★★★★ Excellent
Knowledgeable: Did our employees know what they were talking about? :
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1 ★☆☆☆☆ Poor
2 ★★☆☆☆
3 ★★★☆☆
4 ★★★★☆
5 ★★★★★ Excellent
Prompt and Courteous: Were our employees attentive?:
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1 ★☆☆☆☆ Poor
2 ★★☆☆☆
3 ★★★☆☆
4 ★★★★☆
5 ★★★★★ Excellent
Our Goods
Quality:
*
1 ★☆☆☆☆ Poor
2 ★★☆☆☆
3 ★★★☆☆
4 ★★★★☆
5 ★★★★★ Excellent
Competitive Price:
*
1 ★☆☆☆☆ Poor
2 ★★☆☆☆
3 ★★★☆☆
4 ★★★★☆
5 ★★★★★ Excellent
Any comments/suggestions?
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