ADVS Customer Comment Tracker

ADVS Customer Comment Tracker

The Arizona Department of Veterans' Services welcomes customer feedback from veterans, dependents, families, employees, vendors, and partners. Let us know what's on your mind. AZ State Veteran Home Residents: Please use your home's local feedback process to report issues. (rev. 2022-04-21 lq)
Submission Date

YearMonthDay
Submission Time

:HourMinutesAM/PM Option
Anonymous Option

Anonymous
What is the best way for ADVS to contact you?*

EmailPhonePostal MailNo Contact
Full Name*

First NameMiddle Name/InitialLast Name
Email Address*
imaveteran@email.com
Phone Number*
Phone Type*

Cell PhoneLand LineN/A
Mailing Address*

Street Address

Apt/Unit/Suite

CityState

Zip
Before Completing This Form

Please Note: ADVS is NOT the federal U.S. Department of Veterans Affairs (VA).

Rather, ADVS is an Arizona state agency helping veterans and their dependents with VA benefits. We also connect veterans with both Arizona and other, non-governmental support resources.
What is your Relationship to ADVS?*

I am a: Customer (Veteran, Dependent, Family)I am a: Vendor/Contractor/Partner/OtherAZStateAgencyI am an: ADVS Employee
How would you best characterize this feedback?*

Appointment RequestComplimentComplaintObservationQuestionSuggestion
Need an Appointment Request for a Claim+?

You may receive faster service by calling the ADVS Appointment Hotline at 602-535-1215, connecting you directly to our Veteran Services Division specialists.
Customer / Vendor Section
Select the ADVS Office(s) associated with your feedback.*

I don't knowADVS Director’s OfficePublic & Intergovernmental AffairsAdministration: Business OfficeAZ State Veteran Home-PHXAZ State Veteran Home-TUCAZ State Veteran Home-FLGAZ State Veteran Home-YUMVSD: Veteran Benefit CounselorsVSD: AZ Veterans’ CemeteryADVS: State Approving Agency (SAA)
Feedback Category*

Customer ServiceInformationNeeds Not MetSafetyWait TimeOther
Employee Section
Select the ADVS Division in which you work.*

Director’s OfficePublic & Intergovernmental AffairsAdministration DivisionArizona State Veteran Home FlagstaffArizona State Veteran Home PhoenixArizona State Veteran Home TucsonArizona State Veteran Home YumaVeteran Services Division (VSD)I prefer not to answer this questionI don't know
Select the ADVS Division to which your feedback pertains.*

Director’s OfficePublic & Intergovernmental AffairsAdministration DivisionArizona State Veteran Home FlagstaffArizona State Veteran Home PhoenixArizona State Veteran Home TucsonArizona State Veteran Home YumaVeteran Services Division (VSD)I prefer not to answer this questionI don't know
What is the nature of your Employee feedback?*

Abuse/Fraud/WasteAppreciationBenefits/SalaryEquipmentHarrassmentPeer MisconductProfessionalismSafetySupervisionTrainingOther
Attention!

Please note the Abuse/Fraud/Waste selection is specifically in regards to business resources such as time, money, supplies, and equipment. If you wish to report abuse of a State Veteran Home Resident, please contact the Abuse Officer of the facility in question. If you wish to report employee abuse of any kind, please contact the agency's Human Resources unit.
Comments Section

Please provide a brief narrative (150 words or less) describing your Compliment, Complaint, Observation, Question, or Suggestion. ADVS Goal: Respond to customers within 5 business days.
Customer Comments*

0/500
Please verify that you are human*
ADVS Staff Use Only
ADVS Staff-Use-Only Section

This section is hidden to customers, and used for ADVS management response tracking.
Assign to ADD Date

YearMonthDay
Assign to ADD Staff Member (will receive emails)*

UnassignedDirector - John ScottDD Services - Dana AllmondRC Admin - Jeffrey CookPIAVSD - Gary OchoaLiaisonAdministration - Jack BeasleyASVH-FLA - Cameron FarrASVH-PHX - Jermaine WilliamsASVH-TUC - Robert TunilaASVH-YUM - David Barrientos
Resolution Status

UnassignedAssignedActiveResolvedRevisitScheduledUnresolved/Unresolvable
Resolution Comments*

Find a solution...
0/1000
Resolution Date

YearMonthDay
Customer Follow-up Contacts

The Feedback Types of: Appointment Request, Question, and Complaint ALWAYS REQUIRE a Customer Follow-up Contact, whereas the Feedback Types of: Compliment, Information, and Suggestion may not require follow-up. In those cases, follow-up is discretionary.
Customer Contacted for Resolution? (Note: Allow 3 business days for customer responses)

YesNoN/A (feedback type doesn't require it)
Customer Satisfaction Level (as/if received by assigned ADVS representative)

5-Overwhelmed (WooHOO!)4-Satisfied (Better)3-Neutral (Good)2-Underwhelmed (M'eh...)1-Dissatisfied (Unhappy)0-NotApplicable/NotRequired
Customer Closure Acceptance Date

YearMonthDay
Days-to-Assign
Days-to-Resolve
Days-to-Close
Should be Empty:

ADVS Customer Comment Tracker

Need an Appointment Request for a Claim+?

Customer / Vendor Section

Employee Section

Attention!

Comments Section

ADVS Staff-Use-Only Section

Customer Follow-up Contacts