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* 2. Name of Staff Member

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* 3. Reliability - The ability to deliver the promised service in a 'Consistent and Accurate' manner

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* 4. Assurance - The 'Knowledge level and Politeness' and to what extend 'Trust and Confidence' was created

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* 5. Empathy - To what extent care and individual attention was given

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* 6. Responsiveness - Willingness to offer speedy service

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* 7. Appearance (optional)

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* 8. Do you have any other comments, questions, or concerns?

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