Customer Satisfaction Survey

Serving our customers is a top priority. We encourage you to leave feedback using the form below.

Please note: If you are a policy-holder we encourage you to provide feedback with your insurance company.

Your File #

Insured's Name

Core File #

Adjuster's Name

Your Name

Company

Phone Number

Email Address

Touchpoints

	Very Dissatisfied	Somewhat Dissatisfied	Neither	Somewhat Satisfied	Very Satisfied
Response Time	Response Time - Very Dissatisfied	Response Time - Somewhat Dissatisfied	Response Time - Neither	Response Time - Somewhat Satisfied	Response Time - Very Satisfied
Compliance	Compliance - Very Dissatisfied	Compliance - Somewhat Dissatisfied	Compliance - Neither	Compliance - Somewhat Satisfied	Compliance - Very Satisfied
Investigation	Investigation - Very Dissatisfied	Investigation - Somewhat Dissatisfied	Investigation - Neither	Investigation - Somewhat Satisfied	Investigation - Very Satisfied
Report Timeliness	Report Timeliness - Very Dissatisfied	Report Timeliness - Somewhat Dissatisfied	Report Timeliness - Neither	Report Timeliness - Somewhat Satisfied	Report Timeliness - Very Satisfied
Adjuster	Adjuster - Very Dissatisfied	Adjuster - Somewhat Dissatisfied	Adjuster - Neither	Adjuster - Somewhat Satisfied	Adjuster - Very Satisfied
Cost	Cost - Very Dissatisfied	Cost - Somewhat Dissatisfied	Cost - Neither	Cost - Somewhat Satisfied	Cost - Very Satisfied
Overall Quality	Overall Quality - Very Dissatisfied	Overall Quality - Somewhat Dissatisfied	Overall Quality - Neither	Overall Quality - Somewhat Satisfied	Overall Quality - Very Satisfied

Additional Comments

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