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4151 Kilmer Drive
Burlington, Ontario
L7M 5A9 (map)
(905) 315-2500

RETIREMENT RESIDENCE

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ACCESSIBLE CUSTOMER SERVICE FEEDBACK FORM

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Thank you for visiting Heritage Place. Your feedback is important to us. We consistently strive to improve accessibility for all our customers to meet their needs.

Please take a few moments to share your experience with us today.

2. Approximate time of your visit: please click to view and choose time

02:30 PM

3. Departments visited:

4. Were you satisfied with our customer service today?

YES

5. Did you have any problems with accessing our goods, services, and/or faicilities?

YES

If YES, please explain:

6. What, in your opinion, can we do to resolve this problem?

7. May we contact you for additional information?

YES

If YES, please state your address and telephone number:

In order for us to solve this problem efficiently and to help us better serve you and others in the future, please complete the following information.

Do you currently have a disability?

YES

If YES, please explain:

Please select your appropriate age range:

Less than 19

20-29

30-39

40-49

50-59

60-69

Over 70

I agree to allow Heritage Place to use the information collected on this form.