Thank you for taking the time to participate in this survey. Providing excellent customer service is a top priority for Applied Geologics Inc. (AGL). Your response will assist us in evaluating current performance and identifying areas for future improvement.

This should take less than 5 minutes to complete. If you have any questions regarding the survey, please call 1 877 433-9533.

    Government Organization Name "*"


    First Name"*"

    Last Name"*"

    Job Title "*"

    Department "*"

    Email Address "*"

    Phone Number (xxx-xxx-xxxx) "*"

    *Note that the radio buttons below may not appear to be selected when clicked on. This is a flaw with the website template. Rest assured your selection will be recorded upon submitting the form.

    How responsive have we been to your questions or concerns? "*"

    Extremely responsiveVery responsiveSomewhat responsiveNot very responsiveNot at all responsive

    How well did we understand your questions and concerns? "*"

    Extremely wellVery wellSomewhat wellNot very wellNot at all well

    How important do the employees at AGL make you feel? "*"

    Extremely importantVery importantSomewhat importantNot very importantNot at all important

    How likely is it that you would recommend AGL to a friend or colleague? "*"

    Not at all likely 012345678910 Extremely Likely

    What changes would AGL have to make for you to give it an even higher rating?

    Would you like to be contacted by an AGL Representative regarding your response to this survey? "*"


    To Submit, please first enter the the following characters into the field below "*"