Nor-Cal Medical Temps - Quality Assurance Form

Feedback

Quality Assurance Form

We at Nor-Cal value your opinion concerning the quality of our service and the people that we provide. We feel that maintaining the highest level of customer satisfaction requires constant interaction and feedback. Responding to the “Quality Assurance Form” will help us to ensure your continued satisfaction with our program.

First, we would like you to rate the quality of our pharmacy personnel in the following areas:

Our employee
	Did Not Meet Expectations	Did Meet Expectations	Exceeded Expectations
Attendance
Productivity
On the Job Professionalism
Positive Attitude
Overall Impression
Would you like to have this employee back at your facility again?	Yes No
Additional comments:

Now we would like your feedback concerning the quality of our customer service team:

Service team member name (optional)
	Did Not Meet Expectations	Did Meet Expectations	Exceeded Expectations
Responsiveness
Follow-up
Professionalism
Additional comments: