Social Services Customer Feedback Form

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Please correct the field(s) marked in red below:

Chatham County Social Services wants to hear from you about your interactions with our staff.  Thanks so much for taking the time to let us know how we are doing and what we can do better.  You will have the option at the end to provide contact information if you want us to get back to you or if you want to be eligible for a monthly drawing for a WalMart gift card. 

1
Which Social Services program(s) are related to your visit or contact with our office? Check all that apply.
Which Social Services program(s) are related to your visit or contact with our office? Check all that apply.
2
Was your interaction with staff by (select all that apply):
 *
Was your interaction with staff by (select all that apply):
3
If you know it, please provide the name of the person you interacted with below:
4
Please rate your staff interaction on several factors below, on a scale from poor to excellent.
Please rate your staff interaction on several factors below, on a scale from poor to excellent.
Poor Fair Good Very Good Excellent
Courteous & respectful
Knowledgeable or got me to someone who could help
Listened to my needs
Gave clear explanations and responses to my questions
5
The employee understood my situation and wished to help (even if unable to do so).
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The employee understood my situation and wished to help (even if unable to do so).
6
The employee responded promptly within one workday of receipt or contact.
The employee responded promptly within one workday of receipt or contact.
7
Please provide any specific information regarding your interaction with staff that might help us improve or to know what we are doing well. 
8
Would you like us to contact you regarding any of your survey responses.  If so, please make sure you provide your contact information below. 
Would you like us to contact you regarding any of your survey responses. If so, please make sure you provide your contact information below.
9
WALMART GIFT CARD:  If you wish to be included in a monthly drawing for a Walmart gift card for completing this survey, please check this box and provide your name and contact information below
10

OPTIONAL CONTACT INFORMATION:

OPTIONAL CONTACT INFORMATION:
  1. To receive a copy of your submission, please fill out your email address below and submit.