Eligibility Customer Satisfaction Survey

Dear Customer,

The County of San Diego is committed to provide every one of our customers with a positive experience and we would like to hear your thoughts. Your input will help us provide exceptional service and your responses will be kept strictly confidential, if requested. Thank you for your participation.

Please complete the Customer Satisfaction Survey below to help us serve you better.

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* 1. Purpose of your visit/contact:

Application

Renewal

Provide documents

Information

Appeals

Other

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* 2. Date of visit:

Date

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* 3. Please select location:

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* 4. Which of the following best describes you?

Recent applicant

Family Member or Authorized Representative

Current Customer/Recipient

Provider, advocate

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* 5. Did you receive courteous service?

Yes

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* 6. Were you satisfied with the information you received?

Yes

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* 7. Who was the staff person who served you?

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* 8. What did we do well?

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* 9. What could we have done better?

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* 10. Overall are you satisfied with the service you received?

1-Strongly Disagree

2-Disagree

3-Agree

4-Strongly Agree

1-Strongly Disagree

2-Disagree

3-Agree

4-Strongly Agree

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* 11. If you would like a response to any of your comments, please provide your full name, address and phone number below (optional):

First Name

Last Name

Address

City

Zip Code

Daytime phone number

E-mail address