CLIENT SATISFACTION MEASUREMENT FORM
REV 05 | 05 OCT 2023
Policy Development and Planning Section (PDPS)

Good Day Sir/Madam,

We would like to get a few moments of your time in order for us to get know you better. We consider it our duty to do our best in meeting your research request needs and expectations. But we also need your help. May we seek your assistance in improving our services by providing us with your comments and suggestions. Kindly fill-out the below client satisfaction survey and write your comments and suggestions in the space provided (if any). Rest assured that all data provided in this form will only be used in providing better services from the DSWD-NCR in compliance to all applicable regulatory and privacy laws. Thank you.
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Email *
CERTIFICATE OF INFORMED CONSENT
I voluntarily give my consent for the use of my personal information. I confirm that I have read the provided information, or it has been read to me. I have had the opportunity to ask questions about it, and any inquiries I made were answered to my satisfaction. I understand that any information collected will be utilized solely to enhance the basic social services provided by DSWD.
 *
DATE OF TRANSACTION *
MM
/
DD
/
YYYY
NAME OF CLIENT (First, MI, Last) *
AGE *
SEX *
CLIENT TYPE *
Required
SECTOR *
Required
CONTACT NUMBER/ EMAIL ADDRESS *
ADDRESS (Barangay, Municipality, Province) *
NAME OF ATTENDING ACTION OFFICER *
NAME OF SERVICE/ FUNCTION AVAILED *
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