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.

Question Title

* 1. When did you visit us?

Date / Time

Date

Question Title

* 2. Did we respond to your needs on this visit?

Yes

Somewhat

No (please explain below)

Please explain:

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

Yes

Somewhat

No (please explain below)

Please explain:

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* 4. Did you have any problems accessing our goods and/or services?

Yes (please explain below)

Somewhat (please explain below)

No

Please explain:

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* 5. Do you have any other comments, questions, or concerns in regards to the accessibility of our services?

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