Hart District Council - Customer feedback form

What was your reason for contacting us? *

Please specify

What department did you speak with? *

Please specify

How did you contact us? *

Please specify

Were you directed to the correct department?

Yes

No

Did an officer come and see you and introduce themselves?

Yes

No

Was this your preferred option? *

Yes

No

What is your preferred method of contact?

On a scale of 1 – 4 (1 low – 4 high) we were: *

	1	2	3	4
Helpful	Helpful - 1	Helpful - 2	Helpful - 3	Helpful - 4
Approachable	Approachable - 1	Approachable - 2	Approachable - 3	Approachable - 4
Responsive - to your enquiry	Responsive - to your enquiry - 1	Responsive - to your enquiry - 2	Responsive - to your enquiry - 3	Responsive - to your enquiry - 4
Take ownership - of your enquiry	Take ownership - of your enquiry - 1	Take ownership - of your enquiry - 2	Take ownership - of your enquiry - 3	Take ownership - of your enquiry - 4

On a scale of 1 – 4 (1 low – 4 high) how satisfied were you with the following: *

	1	2	3	4
Time taken	Time taken - 1	Time taken - 2	Time taken - 3	Time taken - 4
Enquiry dealt with in a positive manner	Enquiry dealt with in a positive manner - 1	Enquiry dealt with in a positive manner - 2	Enquiry dealt with in a positive manner - 3	Enquiry dealt with in a positive manner - 4
Sympathetic to your needs	Sympathetic to your needs - 1	Sympathetic to your needs - 2	Sympathetic to your needs - 3	Sympathetic to your needs - 4
The outcome of your enquiry	The outcome of your enquiry - 1	The outcome of your enquiry - 2	The outcome of your enquiry - 3	The outcome of your enquiry - 4
Information provided was accurate and clear	Information provided was accurate and clear - 1	Information provided was accurate and clear - 2	Information provided was accurate and clear - 3	Information provided was accurate and clear - 4

On a scale of 1 – 10 (1 low – 10 high) for your overall experience, how would you rate our customer service? *

Please leave any further comments/suggestions regarding the service you received

Confirmation box

Please tick this box if you are happy to be contacted regarding your answers

Name: *

Contact number: *

Email: *

Equality monitoring questions

Please note that these fields are not mandatory.

The information you give us will only be used to understand if any of the feedback (such as dissatisfaction) is particular to specific groups of people.

How would you describe your ethnic group?

White

Mixed or Multiple Ethnic Groups

Asian or Asian British

Black or Black British

Please specify:

Do you consider yourself to have a disability as defined by the Disability Discrimination Act 1995 (2005)?

A person has a disability for the purposes of this Act if s/he has a physical or mental impairment, which has a substantial and long-term adverse effect on her/his ability to carry out day-to-day activities.

What is your gender?

In which age category are you?