Type of service (e.g. restaurant): Name of company:
Date of encounter: Time of encounter:
Describe specific circumstances which led up to this
encounter:
Describe the encounter in as much detail as possible:
Rate your satisfaction on a scale of 1 to 7 where 1 is extremely dissatisfied and 7 is extremely satisfied:
Describe what made you feel this way (level of satisfaction):
Describe anything the employee/firm could have done
to make you happier with the encounter:
Rate the likelihood of your going back to this service firm on a scale of 1 to 7 where 1 is extremely unlikely and 7 is extremely likely:
Rate the likelihood of your recommending this service to a friend on a scale of 1 to 7 where 1 is extremely unlikely and 7 is extremely likely:
Discuss any other perceptions or feelings about this
encounter and apply any concepts you feel are relevant from the text or
readings assigned:
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