Accessible Customer Service Feedback Form

If you require follow up, please provide contact information where you can be reached.

First and Last Name (optional)

Date

Email Address (optional)

Phone Number (optional)

Please tell us the facility, date and time of your visit:

Did we respond to your customer service needs today?

Yes

Was our customer service provided to you in an accessible manner?

Yes

Did you have any problems accessing our goods and services?

Yes (explain below)

Somewhat (explain below)

Please add any other comments you may have

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