NAME:______________________________ PHONE #:_____________________
TYPE LOSS:__________________ DATE:___________ COMPANY:___________
The purpose of this form is to help us evaluate our claims service to you. Your honest answers and comments will help us evaluate our insurance company's service. If you wish to discuss this matter in person, please call us.
1. Was our office courteous, prompt, and efficient in taking care of your claim?
_________GOOD __________FAIR ___________POOR
Comments:________________________________________________________
2. Do you feel the policy you have with us needs any additional explanation? ____YES ____NO
Comments:________________________________________________________
3. Was the insurance company adjuster who handled your claim for you courteous, prompt, and efficient in taking care of your claim? __________GOOD _________FAIR ________POOR
Comments:________________________________________________________
4. Was the settlement of your claim fair and honest? _____YES _____NO
Comments:________________________________________________________
THANKS SO MUCH FOR YOUR HELP!
GOOD FAIR POOR N/A TOTALS
OFFICE SERVICE (#1) 58 2 1 61
ADJUSTER SERVICE (#3) 48 3 4 6 61
YES NO NO ANSWER
ADDTL POLICY INFO? (#2) 1 60 61
FAIR SETTLEMENT? (#4) 57 4 61