Client Service Survey

Were your questions and our responses handled professionally, politely, and promptly? *

Yes

No

Comment: *

Who assisted you? *

What can we do to assist you better? *

Please rate the timeliness of responses that you received from your agency representative. *

How would you rate the quality of the responses to your questions and concerns? *

How effective are our methods of communications? *

What should we improve on? (Please be specific)

What do we do well? (Please be specific)

Partnering and Commitment

Would you like information on any of the following products/services available through Cal-Valley Insurance? *

Please provide any additional comments:

First Name: *

Last Name: *

Phone:

Email Address: *

Preferred Method of Communication:

Group Health Insurance	Group Life Insurance
Short-Term/Long-Term Disability	Homeowners/Renters Insurance
Boat/RV/Motorcycle Insurance	Bond and/or Surety Products
Business Insurance	Individual Health Insurance
Individual Life Insurance	Long-Term Care Insurance
Personal Auto Insurance	Umbrella Coverage
Workers' Compensation	Commercial Auto Insurance
Other