Accident No:
Accident Date:
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1992
Professionalism:
Please Select
Very Satisfied
Fairly Satisfied
Neither Satisfied Nor Dissatisfied
Fairly Dissatisfied
Very Dissatisfied
Knowledge:
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Very Satisfied
Fairly Satisfied
Neither Satisfied Nor Dissatisfied
Fairly Dissatisfied
Very Dissatisfied
Helpfulness / Customer Service:
Please Select
Very Satisfied
Fairly Satisfied
Neither Satisfied Nor Dissatisfied
Fairly Dissatisfied
Very Dissatisfied
Pro-activeness
Please Select
Very Satisfied
Fairly Satisfied
Neither Satisfied Nor Dissatisfied
Fairly Dissatisfied
Very Dissatisfied
Contacting us by phone:
Please Select
Very Satisfied
Fairly Satisfied
Neither Satisfied Nor Dissatisfied
Fairly Dissatisfied
Very Dissatisfied
Clarity of Correspondence:
Please Select
Very Satisfied
Fairly Satisfied
Neither Satisfied Nor Dissatisfied
Fairly Dissatisfied
Very Dissatisfied
Empathy with your situation:
Please Select
Very Satisfied
Fairly Satisfied
Neither Satisfied Nor Dissatisfied
Fairly Dissatisfied
Very Dissatisfied
Timeliness to Settle:
Please Select
Very Satisfied
Fairly Satisfied
Neither Satisfied Nor Dissatisfied
Fairly Dissatisfied
Very Dissatisfied
General Comments