Pro Bono Agent Feedback Form
Share your feedback on your experience with a pro bono agent to help us recognize great service and improve our program.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Agent's Full Name
*
First Name
Last Name
Date of Service
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Service Provided
*
Please Select
Legal Advice
Consultation
Representation
Mediation
Other
How would you rate the agent's professionalism?
*
1
2
3
4
5
Please rate the agent's communication skills
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
How satisfied are you with the outcome of the service?
*
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
What was the most helpful aspect of the agent's assistance?
Do you have any suggestions for improvement?
May we use your feedback (anonymously) for training or promotional purposes?
*
Yes, I consent
No, I do not consent
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