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Dear Valued Client,: Raquel O. Alivio

The document is a survey from a researcher evaluating the services of the Municipal Civil Registry Office in Lucban Quezon. It requests the participant's demographic information and asks them to rate their satisfaction with the office's reliability, responsiveness, assurance, empathy, and tangibles across five dimensions on a scale of 1 to 5. The survey aims to study the quality of services provided by the civil registry office.

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Prances Pelobello
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48 views3 pages

Dear Valued Client,: Raquel O. Alivio

The document is a survey from a researcher evaluating the services of the Municipal Civil Registry Office in Lucban Quezon. It requests the participant's demographic information and asks them to rate their satisfaction with the office's reliability, responsiveness, assurance, empathy, and tangibles across five dimensions on a scale of 1 to 5. The survey aims to study the quality of services provided by the civil registry office.

Uploaded by

Prances Pelobello
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Dear Valued Client,

I would like to ask for your participation in answering this survey form regarding the
quality of service of the Municipal Civil Registry of Lucban Quezon. I am currently conducting
a study entitle “An Evaluation of the Services Provided by the Civil Registry Office in Lucban
Quezon”. Be assured that your answers will be treated with utmost confidentiality.

Raquel O. Alivio
Researcher

Part 1. Demographic bSurvey. Please provide the necessary information by putting a check
mark on the side provided for in each item.

Name: (optional) _______________________

Age: ____ 18 to 25 years old ____ 46 to 50 years old


____ 26 to 30 years old ____ 51 to 55 years old
____ 31 to 35 years old ____ 56 to 60 years old
____ 36 to 40 years old ____ 61 years old and
____ 41 to 45 years old above

Gender: ____ Male


____ Female

Marital Status:
____ Single
____ Married
____ Separated
____ Annulled

Record / Document requested from the Municipal Civil Registry Office of Lucban
____ Birth Certificate
____ Death Certificate
____ Certificate of Marriage
____ Others, please specify __________________
Part II. Survey on Service Quality

Please state your level of satisfaction on the services of the Municipal Civil Registry
Office of Lucban Quezon as regards the five dimensions of service quality. You may
use the following legends as you put a check mark on your appropriate boxes below:

5 - Excellent
4 – Very Satisfactory
3 – Satisfactory
2 – Fair
1 – Poor

Reliability 1 2 3 4 5

Performing the service right for the first time

Customer expectation is strictly followed

Efficiently carries out the service

Accuracy of the information received

Relevance of the information received

Responsiveness 1 2 3 4 5

Readiness to respond to customers’ request

Keeping the customers informed

Entertain/Greet customers upon serving

The office as convenient operating hours

Willingness to attend to customers’ needs

Assurance 1 2 3 4 5

Making customers feel secure about


transactions

Completeness of information received

Staff are knowledgeable about customers’


concerns
Staff assures the customers’ safety

Staff are courteous with you

Empathy 1 2 3 4 5

Staff have a pleasant demeanor

Staff pays customers personal attention

Staff are polite and ready to entertain questions

Staff always listens to the customers

Staff understands the needs of the customers

Tangibles 1 2 3 4 5

Cleanliness of the office

Staff is appropriately dressed

Has comfortable waiting area

Has entertainment facilities like music,


television, etc.

State-of-the-art documentation

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