Client Feedback Form

📱➡️🖥️

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This feedback form is best experienced in landscape mode!

(Paki-ikot po ang inyong cellphone para mas madaling basahin)

This Client Satisfaction Measurement (CSM) tracks the customer experience of government offices. Your feedback on your recently concluded transaction will help this office provide a better service. Personal information shared will be kept confidential and you always have the option to not answer this form.

📝 Transaction Details

Please tell us what service you availed today.

Select Office Visited:

Service Availed *

👤 Demographic Information

Please provide your basic details.

Client Type:

Citizen Business Government

Sex:

Male Female

Age:

Region of Residence:

Citizen's Charter (CC)

INSTRUCTIONS: Check mark (✓) your answer to the Citizen's Charter (CC) questions. The Citizen's Charter is an official document that reflects the services of a government agency/office including its requirements, fees, and processing times among others.

Service Quality Dimensions (SQD)

INSTRUCTIONS:
For SQD 0-8, please put a check mark (✓) on the column that best corresponds to your answer.

Dimensions	Strongly Disagree (1)	Disagree (2)	Neither Agree nor Disagree (3)	Agree (4)	Strongly Agree (5)	N/A
SQD0 – I am satisfied with the service I availed
SQD1 – I spent a reasonable amount of time for my transaction
SQD2 – The office followed the transaction's requirements and steps based on the information provided
SQD3 – The steps (including payment) I needed to do for my transaction were easy and simple
SQD4 – I easily found information about my transaction from the office or its website
SQD5 – I paid a reasonable amount of fees for my transaction
SQD6 – I feel the office was fair to everyone, or walang palakasan, during my transaction
SQD7 – I was treated courteously by the staff, and (if asked for help) the staff was helpful
SQD8 – I got what I needed from the government office, or (if denied) denial of request was sufficiently explained to me

Suggestions / Commendations

Email Address (Optional):

Republic of the Philippines
Province of Benguet
Municipality of Tuba

Client Satisfaction Survey

Tap anywhere to begin

CC1	I know what a CC is and I saw this office's CC I know what a CC is but I did NOT see this office's CC I learned of the CC only when I saw this office's CC I do not know what a CC is and I did not see one in this office
CC2	Easy to see Somewhat easy to see Difficult to see Not visible at all Not applicable
CC3	Helped very much Somewhat helped Did not help Not applicable

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📝 Transaction Details

👤 Demographic Information

Client Satisfaction Survey