Customer feedback Form of Nueva Vizcaya

Thank you for visiting the Provincial Government of Nueva Vizcaya.

Help us improve our services by answering the following questions.
I. FEEDBACK INFORMATION

(detalye ng feedback)
1. This feedback is a *

compliment (papuri sa magandang asal) complaint (reklamo sa di magandang asal) suggestion (mungkahi upang lalong mapaganda ang serbisyo) Other
2. I am providing feedback based on *

my own experience the experience of others I personally know the experience of others I dont personally know.
2. I am providing feedback based on *

my own experience. the experience of others.
II. PERSONAL DETAILS

Your personal details will be used to verify the truthfulness and veracity of your feedback only.This document, its contents, and any attachments included are privileged, confidential, and exclusively for the intended recipient. No part of this document may be reproduced or exhibited without the written consent of the client and the PLGU. In case of wrongful receipt of or unauthorized access to this material, please immediately inform the author and permanently delete wrongfully received copies.
3. Client's Full Name: (Pangalan ng Kliyente) *

First Name Last Name
4. Which age group do you belong? *

Below 18 years old 19 - 30 years old 31- 45 years old× 46- 55 years old 56- 64 years old 65 years old and above.
5. Complete Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
6. E-mail Address *
example@example.com
7. If you wish to get an update about our action on your feedback, provide your contact number. This will not be shared to anyone without your consent.
III. SERVICE INFORMATION
8. Name of office visited (opisinang pinuntahan) *
9. Date of visit *

Month Day Year
Time of visit *

Hour Minutes

AM/PM Option
11. What is the purpose of your visit? *

To inquire To follow up To submit a request or seek assistance To transmit an official correspondence To pay for Taxes/Fees/Dues To attend a meeting Courtesy call To claim an approved request Other
12. Your overall opinion on the location of the office. *

Excellent Good Neutral Poor Very poor
13. Your overall opinion on Fast Delivery of Service? *

Excellent Good Neutral Poor Very poor
14. Rate the cleanliness and Orderliness of the Office. *

Excellent Good Neutral Poor Very poor
15. What is your overall opinion on the courteousness of its employees? *

Excellent Good Neutral Poor Very Poor
16. Rate the quality of service you have received. *

Excellent Good Neutral Poor Very Poor
17. Overall rating of Customer Satisfaction *

Excellent Good Neutral Poor Very Poor
18. If you have some suggestions or comments, pls provide details here.
19. If you have any complaint, pls provide details against the office, action taken, service given, or an employee or official.
2o. If you wish to compliment a good act, an excellent service, a good deed or a person, pls provide details here or mention the name of the employee or official who deserves your appreciation.
20. Will you recommend to others, the frontline services of the PLGU Nueva Vizcaya?

Definitely, Yes. Maybe. No Never
Click if you agree *

I hereby authorize the PLGU Nueva Vizcaya to process the data indicated in this survey for the purpose of improving their services. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012 and that I am required to give truthful information in accordance with Philippine laws.
PAPURI SA EMPLEYADO
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Thank you for visiting the Provincial Government of Nueva Vizcaya.

I. FEEDBACK INFORMATION

II. PERSONAL DETAILS

III. SERVICE INFORMATION