AODA Form

AODA Form

• Date of your visit / MM / DD YYYY
  
• Were you satisfied with the customer service we provided you? *
  Were you satisfied with the customer service we provided you?

  Yes No Somewhat
• Was our customer service provided to you in an accessible manner? *
  Was our customer service provided to you in an accessible manner?

  Yes No Somewhat
• Did you experience any problems accessing our goods and services? *
  Did you experience any problems accessing our goods and services?

  Yes No Somewhat
• Comments
• Name First Last
• Phone - ### - ### ####
• Email