Client Satisfaction Survey Form
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Email *
Name of Client *
Name of Employee/ Service being rated *
Service Acquired *
Date Accomplished *
MM
/
DD
/
YYYY
Date of Service Acquired *
MM
/
DD
/
YYYY
1. Judicious and Efficient: Having sound judgment, competent and productive. *
🙁 Poor
😀 Outstanding
2. Courteous and Expeditious: Polite and considerate in manner; does thing quick and efficient; response quickly. *
🙁 Poor
😀 Outstanding
3. Fair and Reasonable: Acts without favor and conforming to what is right. *
🙁 Poor
😀 Outstanding
4. Accountable: Act with utmost integrity, take  full responsibility and worth of respect, trust, and confidence. *
🙁 Poor
😀 Outstanding
Any comments for improvement:
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