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Department of Social Services Customer Satisfaction Survey

  1. We want to improve our services for you and your family. Please check one of the boxes in response to each of the 3 questions below to let us know how satisfied or dissatisfied you were with your most recent visit.
  2. The friendliness and respect with which I was treated:
  3. The answers I received for my questions:
  4. The help I received for my problems:
  5. Please check one or more of the 4 boxes below to let us know the reason(s) for your visit.
  6. If you would like us to contact you, please type your area code and phone number below. You may also give us your email address.
  7. Please let us know what you would like to discuss:
  8. Do you receive Food & Nutrition Services ("food stamps")?
  9. Leave This Blank:

  10. This field is not part of the form submission.