MDS CUSTOMER FEEDBACK FORM

1. Please enter (* denotes required field): *Name: *Email:

2. Indicate monthly frequency of interactions with MDS: First Time 11 - 20 Times 2 - 10 Times More than 20 Times

Please indicate the appropriate rating for each of the topics listed below, both in terms of how we did (satisfaction level) and how important that particular aspect is to you. 3. Level of Satisfaction 4. Level of Importance 1 = extremely satisfied 1 = extremely important 2 = very satisfied 2 = very important 3 = somewhat satisfied 3 = somewhat important 4 = not very satisfied 4 = not very important 5 = not at all satisfied 5 = not at all important Greeted in Professional Manner 1 2 3 4 5 1 2 3 4 5 Order (Job) Repeated for Clarity 1 2 3 4 5 1 2 3 4 5 Given Reasonable Completion Time 1 2 3 4 5 1 2 3 4 5 Notified When Job Was Completed 1 2 3 4 5 1 2 3 4 5 Job Completed When Promised 1 2 3 4 5 1 2 3 4 5 Job Completed Correctly 1 2 3 4 5 1 2 3 4 5

5. Comments