SCHOOL CLIENT FEEDBACK FORM SCHOOL CLIENT FEEDBACK FORM

(Your feedback matters. Please help us serve better by taking a few minutes to tell us about the service you (Your feedback matters. Please help us serve better by taking a few minutes to tell us about the service you
received today.) received today.)

Name (Optional): __________________________________ Date: ____/____/_______ Name (Optional): __________________________________ Date: ____/____/_______
Office Visited: _________________________ Phone No. (Optional): _______________ Office Visited: _________________________ Phone No. (Optional): _______________
Purpose of Visit (Please specify): ____________________________________________ Purpose of Visit (Please specify): ____________________________________________
Time Started:________ Time Finished: ________ Time Started:________ Time Finished: ________

Client Satisfaction Rating Client Satisfaction Rating

(Kindly rate the quality of service provided by checking () the appropriate box. (Kindly rate the quality of service provided by checking () the appropriate box.
Please use the rating scale below.) Please use the rating scale below.)
5 – Excellent 2 – Unsatisfactory 5 – Excellent 2 – Unsatisfactory
4 – Very Satisfactory 1 – Poor 4 – Very Satisfactory 1 – Poor
3 – Satisfactory 3 – Satisfactory

5 4 3 2 1 5 4 3 2 1
A. PHYSICAL A. PHYSICAL
The environment is clean and orderly. The environment is clean and orderly.
B. SERVICES B. SERVICES
Your concern was addressed promptly and appropriately. Your concern was addressed promptly and appropriately.
C. PERSONNEL C. PERSONNEL
The employee was courteous and accommodating. The employee was courteous and accommodating.
*OVERALL RATING FOR THE SERVICE PROVIDED: *OVERALL RATING FOR THE SERVICE PROVIDED:
How satisfied are you with the quality of services provided? How satisfied are you with the quality of services provided?

Suggestions/Compliments/Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Thank you for your time, we are happy to serve you.
Suggestions/Compliments/Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Thank you for your time, we are happy to serve you.

*Privacy notice: The personal information included in this document should only be used for the purposes of *Privacy notice: The personal information included in this document should only be used for the purposes of
administering the survey. Any personal information included herein may not be used for other purposes aside administering the survey. Any personal information included herein may not be used for other purposes aside
from those stated above. from those stated above.

Address: Taboc, San Juan, La Union 2500 Address: Taboc, San Juan, La Union 2500
Telephone Number: (072) 6072460 Telephone Number: (072) 6072460
Email Address: 101074@deped.gov.ph Email Address: 101074@deped.gov.ph