Form VS 1-10 VS 1-10 Customer Service Survey

Your answers are voluntary, confidential, and anonymous. They will be used by Veterinary Services to evaluate and improve customer service.
Please fold this survey and return it by mail (postage paid) or in person to the office you visited.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

FORM APPROVED
OMB NUMBER
0579-XXXX

CUSTOMER SERVICE SURVEY

1. IN WHAT CAPACITY DID YOU CONTACT VETERINARY SERVICES?
Pet Animal Import/Export

Farm Animal Import/Export

Product Import/Export

Accredited Veterinarian

Farm Animal Programs

Other (specify)

2. HOW SATISFIED WERE YOU WITH VETERINARY SERVICES IN THE FOLLOWING CATEGORIES?
COURTESY
Satisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Neither Satisfied nor Dissatisfied

Somewhat Dissatisfied

Dissatisfied

Somewhat Dissatisfied

Dissatisfied

PROFESSIONALISM
Satisfied
HELPFULNESS
Satisfied

TIMELINESS
Satisfied
KNOWLEDGE
Satisfied
COMMUNICATION
Satisfied

TREATING YOU AS A VALUED CUSTOMER
Satisfied

Somewhat Satisfied

3. HOW SATISFIED OVERALL WERE YOU WITH YOUR EXPERIENCE IN OUR OFFICE?
Satisfied

Somewhat Satisfied

Neither Satisfied nor Dissatisfied

4. WHAT WAS GOOD ABOUT OUR SERVICE?

5. WHAT COULD WE DO BETTER?

IF YOU WOULD LIKE A RESPONSE FROM VETERINARY SERVICES, PLEASE PROVIDE YOUR NAME AND PHONE OR E-MAIL.
NAME:

PHONE NUMBER :

E-MAIL ADDRESS:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 0579-XXXX. The time required to complete this information collection
is estimated to average .083 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information.
VS 1-10
(JAN 2008)

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PLACE STAMP
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USDA, APHIS, Veterinary Services,
Catherene B. Boyd, Management Analyst,
Eastern Region,
Raleigh, NC 27606,

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REVERSE
VS 1-10