The City of Rock Hill strives to provide you with quality service. Help us to evaluate our service by giving us your opinion of your recent contact with us.

1

Date of Service/Contact

Date of Service/Contact

2

Department/Division that served you:

Department/Division that served you:

3

Name of employee(s) who served you (if known):

Name of employee(s) who served you (if known):

4

Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)

Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)

	1	2	3	4	5
Did we listen attentively to your concern/problem?	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)
How satisfied were you with suggestions offered?	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)
How prompt was our response?	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)
Were you treated courteously?	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)
Did our employee act in a professional and business-like manner?	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)	Please rate the following questions based on a 1 to 5 scale (1 = unsatisfactory and 5 = high satisfaction)

5

Please describe the nature of the service/contact:

Please describe the nature of the service/contact:

6

If you would like a personal follow-up to your concerns, please provide your contact information:

If you would like a personal follow-up to your concerns, please provide your contact information:

First Name:

Last Name:

Email:

Phone Number:

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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