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| Name: |
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| Claim Number: |
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| How would you rate your overall service experience: |
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| How would you rate your experience with the call center: |
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| How would you rate the Technician that completed the repair: |
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| Did the technician explain what was wrong with your TV: |
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| Did the technician explain what was done to repair your TV: |
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| Did the technician clean after himself: |
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| Was the technician courteous and respectful: |
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| How did you hear about us: |
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| Would you recommend us to friends and family: |
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