Name * Address * Contact Phone Number * Email * Date of Service Month MonthDecJanFebMar Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023 Please Choose * pooraveragegoodexcellent 1. How would you rate the level of service you have received from our office staff? * 1. How would you rate the level of service you have received from our office staff? - poor 1. How would you rate the level of service you have received from our office staff? - average 1. How would you rate the level of service you have received from our office staff? - good 1. How would you rate the level of service you have received from our office staff? - excellent 1. A * YesNo Did you receive a return phone call/email promptly? * Did you receive a return phone call/email promptly? - Yes Did you receive a return phone call/email promptly? - No 2. Quality of Service * pooraveragegoodexcellentN/A Floors * Floors - poor Floors - average Floors - good Floors - excellent Floors - N/A Dusting * Dusting - poor Dusting - average Dusting - good Dusting - excellent Dusting - N/A Kitchen * Kitchen - poor Kitchen - average Kitchen - good Kitchen - excellent Kitchen - N/A Bedrooms(s) * Bedrooms(s) - poor Bedrooms(s) - average Bedrooms(s) - good Bedrooms(s) - excellent Bedrooms(s) - N/A Bathroom(s) * Bathroom(s) - poor Bathroom(s) - average Bathroom(s) - good Bathroom(s) - excellent Bathroom(s) - N/A Livingroom * Livingroom - poor Livingroom - average Livingroom - good Livingroom - excellent Livingroom - N/A Overall * Overall - poor Overall - average Overall - good Overall - excellent Overall - N/A Speed and Efficiency of Service * Speed and Efficiency of Service - poor Speed and Efficiency of Service - average Speed and Efficiency of Service - good Speed and Efficiency of Service - excellent Speed and Efficiency of Service - N/A 3. * pooraveragegoodexcellentN/A How would you rate attitude/friendliness of our maid staff? * How would you rate attitude/friendliness of our maid staff? - poor How would you rate attitude/friendliness of our maid staff? - average How would you rate attitude/friendliness of our maid staff? - good How would you rate attitude/friendliness of our maid staff? - excellent How would you rate attitude/friendliness of our maid staff? - N/A How would you rate attitude/friendliness of our maid staff? 4. Pricing ExpensiveAffordableFairEconomical How would you rate the prices of Ana’s Maid Services? How would you rate the prices of Ana’s Maid Services? - Expensive How would you rate the prices of Ana’s Maid Services? - Affordable How would you rate the prices of Ana’s Maid Services? - Fair How would you rate the prices of Ana’s Maid Services? - Economical 5. Referal * YesNo Would you recommend our service to your friends or family? * Would you recommend our service to your friends or family? - Yes Would you recommend our service to your friends or family? - No 6. Any comments or suggestions may help us improve our services? What did you least/most enjoy from your experience with Ana’s Maid Services?