Customer Feedback
Suggestions or comments appreciated. Takes a few minutes. Thank you.
When did you visit us for service?
MM
/
DD
/
YYYY
Please rate our facility for cleanliness and amenities.
dissatisfied
very satisfied
Comments or suggestions for facility.
Your answer
How would you rate the wait time.
dissatisfied
very satisfied
Comments or suggestions for wait time.
Your answer
Please choose one of the following.
Do you feel like you are a valued customer?
dissatisfied
very satisfied
Any other suggestions for improvement.
Your answer
If you would like to be contacted for follow up please enter your Email here.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service