Customer Satisfaction Survey Form

The Client Satisfaction Measurement (CSM) tracks the customer experience of government offices. Your feedback on your recently concluded transaction will help this office provide better service. Personal information shared will be kept confidential and you always have the option to not answer this form.

Client Type
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When did you visit?
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Which office or department did you visit?
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What was the nature / purpose of your visit?
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Service Availed
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Incorporate "Barangay" contact details if necessary
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Select your answer to the Citizen's Charter (CC) questions
CC1 Which of the following best describes your awareness of a CC?
CC2 If aware of CC, would you say that the CC of this office was ...?
CC3 If aware of CC, how much did the CC help you in your transaction?
Please select the best that corresponds to your answer.
SQD0. I am satisfied with the service that I availed.
SQD1. I spent a reasonable amount of time for my transaction.
SQD2. The office followed the transaction's requirements and steps based on the information provided.
SQD3. The steps (including payment) I needed to do for my transaction were easy and simple.
SQD4. I easily found information about my transaction from the offices or its website.
SQD5. I paid a reasonable amount of fees for my transaction.
SQD6. I feel the office was fair to everyone, or “walang palakasan”, during my transaction.
SQD7. I was treated courteously by the staff, and (if asked for help) the staff was helpful.
SQD8. I got what I needed from the government office, or (if denied) denial of request was sufficiently explained to me.
Suggestions on how we can further improve our services
CUSTOMER PROFILE
First Name
Middle Name
Last Name
Email
Gender
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Age
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Barangay
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Address