Customer Feedback

�Please complete the form and be eligible to win a dinner for two.�

How did you hear about Windshield surgeons?
As for friendliness and courtesy, your experience was...
	Excellent
	Satisfactory
	Needs Improvement
As for the value for the money, it was�
	Excellent
	Satisfactory
	Needs Improvement
Based on our experience will you recommend us?
	Yes
	No
And when it came to service, your experience was�
	Excellent
	Satisfactory
	Needs Improvement
How did you find our location overall�
	Excellent
	Satisfactory
	Needs Improvement
What about cleanliness? The place looked�
	Excellent
	Satisfactory
	Needs Improvement
Would you like this form to be entered into a draw for a dinner for two?
	Yes
	No
Email Address
Postal Code
Address
Phone number
Your name
Which location did you visit?
Anything we need to know
May we display your comments publicly as testimonials (i.e. on a web testimonial page)?
	Yes - but only show my first name, last initial and city where my work was done
	Yes - but only show my first name and city
	No - I would prefer not to have my comments shared