Customer Feedback Form With Record Of Customer Feedback Page 2

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Municipality of Strathroy-Caradoc
Record of Customer Feedback
(for Municipal use only)
Date feedback received: _______________________________________________
Name of customer (optional): _________________________________________
Contact information (if appropriate): ___________________________
Details:________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Follow-up: _______________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Action to be taken: ____________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Staff member: _________________________________________________________
Date:__________________________________________________________________

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