Customer Feedback Customer Feedback Form BASIC INFORMATION Your Name Date of Interaction Staff Member’s Name Service Channel In personPhoneEmailChatOther RATING QUESTIONS Please rate the staff member based on your experience (1 = Poor, 5 = Excellent): The staff member was courteous and professional. 12345 They understood my needs clearly. 12345 They resolved my issue efficiently. 12345 I felt valued and respected during the interaction. 12345 They exceeded my expectations. 12345 FURTHER QUESTIONS What impressed you most about your interaction with this staff member? Did they do anything above and beyond your expectations? Would you like to nominate this person as a Service Champion? Why? Would you be willing to be contacted for follow-up if needed? YesNo
