Client Satisfaction Measurement

I

Client Information

Basic details about you and your visit

Client Type

🏠 Citizen 🏢 Business 🏛 Government

Date

Sex

♂ Male ♀ Female

Age

Region of Residence

Office

Service Availed

⚠ Please fill in your age, and select an office and service.

Step 1 of 4 — Client Information

II

Citizen's Charter (CC) Awareness

An official document reflecting office services, requirements & fees

CC1

Which of the following best describes your awareness of a Citizen's Charter (CC)?

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. (N/A on CC2 & CC3)

CC2

If aware of CC (answered 1–3 in CC1), would you say that the CC of this office was…?

CC3

If aware of CC (answered codes 1–3 in CC1), how much did the CC help you in your transaction?

Helped very much Somewhat helped Did not help N/A

⚠ Please answer all CC questions before proceeding.

Step 2 of 4 — Citizen's Charter

III

Service Quality Dimensions (SQD 0–8)

Check the column that best corresponds to your experience

Statement	😠Strongly Disagree	😕Disagree	😐Neither	🙂Agree	😄Strongly Agree	N/A

⚠ Please rate all 9 service quality items before proceeding.

Step 3 of 4 — Service Quality

IV

Additional Feedback

Optional suggestions and contact information

Suggestions on how we can further improve our services (optional)

Email Address (optional)

Step 4 of 4 — Final Step

Cagayan State University — Lasam Campus

Help Us Serve You Better!

Client Information

Citizen's Charter (CC) Awareness

Service Quality Dimensions (SQD 0–8)

Additional Feedback

Thank You!