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1
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Park Facility Name
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2
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Date of visit
| Month | Day | Year | Time |
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3
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How did you hear about us?
| Internet search |
| Recreation & Parks Guide |
| Newspaper/magazine |
| TV/radio |
| Friend/referral |
| Other |
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4
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How often do you visit this facility?
| First Visit |
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| Weekly |
| Monthly |
| Several times a year |
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5
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How would you rate our services?
1
Excellent | 2
Good | 3
Fair | 4
Poor | No opinion/N.A.
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| Courtesy of staff |
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| Helpfulness of staff |
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| Quality of service or program |
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| Meeting your activity needs |
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| Cleanliness of facility |
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| Safety of facility |
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6
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Select ONLY the 3 service factors most important to you and rank them in order of importance (1-3).
1
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| Courtesy of staff |
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| Helpfulness of staff |
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| Quality of service or program |
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| Meeting your activity needs |
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| Cleanliness of facility |
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| Safety of facility |
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7
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Would you recommend this facility to family or a friend?
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8
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If you live in Montgomery County please, let us know your zip code by choosing one of the options below. If you do not live in Montgomery County skip to the following question.
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9
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If you don't live in Montgomery County, please specify your zip code.
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10
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Your comments or suggestions are important to us:
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