Client Feedback Survey   First Name:* Last Name:* Company:* Best number to contact you: E-mail address: Date of Service: MIS Representative: Jordan Ofri Luis Perez Rob Kennedy Donna Dunn Other If other representative please indicate: Representative's professionalism (1=poor - 5=excellent): 1 2 3 4 5 Primary objective(s) of visit: To what degree was the primary objective met? (1=not at all - 5=completely) 1 2 3 4 5 Is there anything our representative could have done differently or better during this visit in order to have met your primary objective(s) more efficiently or effectively? Other comments about this visit or our representative: Do we need to contact you about any outstanding or additional issues? Yes No If yes, please describe the issues: How likely are you to recommend MIS to others? (1=will not - 5=very likely) 1 2 3 4 5 Elaborate if you wish   * Indicates field is required.