Customer Satisfaction Survey

Customer Satisfaction Survey
Date of service:

MonthDayYear
To better serve you in the future, please answer the following:
I was helped in a timely manner.

YesNo
I was treated with respect.

YesNo
I received the information/services I needed.

YesNo
I was informed about other LCCAP or community services.

YesNo
I would recommend LCCAP to friends and/or family.

YesNo
The building and facilities are clean and accessible.

YesNo
Comments/how can we better serve you ?
If you are willing to participate in a discussion group to help LCCAP continue to improve services, please provide your contact information.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Should be Empty: