Client Feedback Form

Central Luzon Provinces Mission of Seventh-day Adventists 1831 Street Mt. View Subdivision 2009, Angelito, Angeles, Pampanga

Seventh-day Adventists are devoted to helping people understand the Bible to find freedom, healing, and hope in Jesus.

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Dear Valued Client,

We are committed to providing excellent service. Please help us improve by giving feedback on your recent interaction with our office staff. This form is intended for pastors, lay members, teachers, literature evangelists, and other stakeholders.

A. Client Information (Optional)

Name

First

Last

Role

Date of Visit/Interaction

Department/Staff Visited

B. Rating Scale

Score	Description
5	Excellent – Exceeded my expectations
4	Very Good – Met my expectations well
3	Satisfactory – Acceptable service
2	Needs Improvement – Some concerns encountered
1	Poor – Did not meet expectations
N/A	Not Applicable

C. Service Evaluation

	Excellent	Very Good	Satisfactory	Needs Improvement	Poor	Not Applicable
Courtesy and Respect	ExcellentCourtesy and Respect Excellent	Very GoodCourtesy and Respect Very Good	SatisfactoryCourtesy and Respect Satisfactory	Needs ImprovementCourtesy and Respect Needs Improvement	PoorCourtesy and Respect Poor	Not ApplicableCourtesy and Respect Not Applicable
Promptness and Efficiency	ExcellentPromptness and Efficiency Excellent	Very GoodPromptness and Efficiency Very Good	SatisfactoryPromptness and Efficiency Satisfactory	Needs ImprovementPromptness and Efficiency Needs Improvement	PoorPromptness and Efficiency Poor	Not ApplicablePromptness and Efficiency Not Applicable
Clarity of Communication	ExcellentClarity of Communication Excellent	Very GoodClarity of Communication Very Good	SatisfactoryClarity of Communication Satisfactory	Needs ImprovementClarity of Communication Needs Improvement	PoorClarity of Communication Poor	Not ApplicableClarity of Communication Not Applicable
Helpfulness and Support	ExcellentHelpfulness and Support Excellent	Very GoodHelpfulness and Support Very Good	SatisfactoryHelpfulness and Support Satisfactory	Needs ImprovementHelpfulness and Support Needs Improvement	PoorHelpfulness and Support Poor	Not ApplicableHelpfulness and Support Not Applicable
Services/Processes	ExcellentServices/Processes Excellent	Very GoodServices/Processes Very Good	SatisfactoryServices/Processes Satisfactory	Needs ImprovementServices/Processes Needs Improvement	PoorServices/Processes Poor	Not ApplicableServices/Processes Not Applicable
Overall Satisfaction	ExcellentOverall Satisfaction Excellent	Very GoodOverall Satisfaction Very Good	SatisfactoryOverall Satisfaction Satisfactory	Needs ImprovementOverall Satisfaction Needs Improvement	PoorOverall Satisfaction Poor	Not ApplicableOverall Satisfaction Not Applicable

D. Suggestions and Final Comments

What did you appreciate most?

What can we improve on?

Additional Comments:

Data Privacy

I agree

By selecting “I agree", you are confirming that you allow us to use your information within the bounds of Republic Act 10173 - Data Privacy Act of 2012.

Thank you for your valuable feedback!