Customer Accessibility Feedback Form
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1Customer Accessibility Feedback Form
We value all of our Members and guests and strive to meet everyone’s needs. Please
provide us with your feedback regarding customer accessibility.
Location visited: _________________________________________
Date and time of visit: _____________________________________
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Did we respond to your customer services needs today?
YES
NO
Was our customer service provided to you in an accessible manner?
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□
□
YES
SOMEWHAT
NO
(please explain below)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Did you have any problems accessing our goods and services?
□
□
□
YES
SOMEWHAT
NO
(please explain below)
(please explain below)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Please add any other comments you may have:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contact information (optional)
Name: __________________________________ Telephone number: ____________________
Address: ____________________________________________________________________
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Parent category: Business