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Name: (can be anonymous) Date of Contact: Type of Contact: Phone In Person Other (please explain)
Reason for Visit: Type of license applied for, type of service (refund/document notarized, etc.) or information required Time of day: AM Noon-1:30pm PM
1. Did the receptionist greet you? Yes No
2. What was the name of the receptionist?
3. Was the receptionist courteous and professional? Yes No
4. Did the receptionist address you/check you in, in a timely manner? Yes No
5. Is there any other information about your experience with our receptionist you wish to share? 6. Please rate the service provided by the receptionist. (1 low - 10 high) 1 2 3 4 5 6 7 8 9 10
7. About how long did you have to wait after you checked in before a License Specialist came to wait on you? Within 5 minutes 5-10 minutes 10-15 minutes more than 15 minutes Other (please specify below)
8. Did the License Specialist who was assigned to help you: (select all that apply) Efficiently Handle Visit Provide Accurate Information Assist You Courteously and Professionally Other (please specify below)
9. What was the name of the License Specialist who assisted you? 10. Is there any other information about your experience with the License Specialist that you wish to share? 11. Is there any additional information you would like to share? 12. Please rate your overall experience. (1 low - 10 high) 1 2 3 4 5 6 7 8 9 10
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