ACCESSIBLE CUSTOMER SERVICE FEEDBACK Thank you for visiting the City of Clarence-Rockland. We value all of our customers and strive to meet everyone's needs. We look forward to receiving your feedback in regards to the accessibility of our services. OK Question Title * 1. When did you visit us? Date / Time Date OK Question Title * 2. Did we respond to your needs on this visit? Yes Somewhat No (please explain below) Please explain: OK Question Title * 3. Was our customer service provided to you in an accessible manner? Yes Somewhat No (please explain below) Please explain: OK Question Title * 4. Did you have any problems accessing our goods and/or services? Yes (please explain below) Somewhat (please explain below) No Please explain: OK Question Title * 5. Do you have any other comments, questions, or concerns in regards to the accessibility of our services? OK Question Title * 6. If you would like us to acknowledge receipt of your feedback, please provide your contact information below: Name Address City/Town Province Postal Code Email Address Phone Number OK DONE