BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY • GOVERNOR EDMUND G. BROWN JR.
Customer Service Evaluation Form
Name: _________________________________________ Date: ___________________
Address: _________________________________________________________________
City: ____________________________ State: _________ Zip: ____________________
Telephone Number(s):
Work: (_____)____________ Home: (_____)____________ Mobile (_____)_____________
What was the nature of your contact with the board?
Description of the situation (please use additional pages, if needed):
Date of Contact/Service: ______________
Employee(s) contacted (if
known):______________________________________________
How was this contact made:
□ By Phone □ By Mail □ In Person
This is:
□ A Complaint □ A Comment
Has the problem been resolved?
□ Yes □ No
If not, what resolution are you requesting?
_______________________________________
What suggestions would you provide to the board to avoid such a problem in the future?
____________________________________________________________________
CALIFORNIA BOARD OF OCCUPATIONAL THERAPY
2005 Evergreen Street, Suite 2250, Sacramento, CA 95815-3831
T: (916) 263-2294 F: (916) 263-2701
Resume Templates 1210 Document(s)
