ice.disa.mil
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156.112.106.11
Public Scan
Submitted URL: https://www.feedback.673bhu.org/
Effective URL: https://ice.disa.mil/index.cfm?fa=card&sp=136415&s=982&dep=*DoD&sc=11
Submission: On November 28 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://ice.disa.mil/index.cfm?fa=card&sp=136415&s=982&dep=*DoD&sc=11
Submission: On November 28 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
POST index.cfm
<form action="index.cfm" method="post" id="comment_card" onsubmit="return allowSubmit(this.form);" autocomplete="off">
<input type="hidden" name="fa" value="add_card">
<input type="hidden" name="card_id" value="91464">
<input type="hidden" name="csrf_token" value="5C55C7F644C4FF2DE3DD47095B52B462EC9089AE">
<input type="hidden" name="service_category_id" value="11">
<input type="hidden" name="service_provider_id" value="136415">
<input type="hidden" name="site_id" value="982">
<input type="hidden" name="timeleness_question_id" value="q_110024" id="timeleness_question_id">
<input type="hidden" name="unit_question_id" value="unit_110024" id="unit_question_id">
<section title="Questions" style="background: white; font-size:.9em; margin-bottom: 0px; margin-left: 0px; padding:0 10px 0 10px; line-height:1; font-family: verdana;">
<table cellspacing="0" cellpadding="0" style=" width:100%; margin: 0px 0 0 0; padding:0px; ">
<tbody>
<tr>
<td>
<table width="100%" style="border-top:none; border-left:none; border-right: none;">
<tbody>
<tr height="25">
<td width="40%" align="baseline"> </td>
<td align="center" valign="middle" width="10%">Yes </td>
<td align="center" valign="middle" width="10%">No </td>
<td align="center" valign="middle" width="10%">N/A</td>
<td align="center" valign="middle" width="30%"> </td>
</tr>
</tbody>
</table>
<fieldset title="Were you satisfied with your overall experience?" style=" border: none;">
<table style="width:100%; cellpadding:5px 0 5px 0px; border:none;" border="0" cellspacing="0">
<tbody>
<tr height="25px" bgcolor="EAEAEA">
<td style="font-size : auto;padding:7px;font-style : bold; line-height: 1.3;font-weight : lighter; width: inherit; height:25; ">
<div id="o_43" style="font-weight:500; border:none;">Were you satisfied with your overall experience?</div>
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_43-Yes" style=" display: none;">Yes</label> <input type="radio" id="q_43-Yes" name="q_43" title="Yes" value="1">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_43-No" style=" display: none;">No</label> <input type="radio" id="q_43-No" name="q_43" title="No" value="0">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_43-N/A" style=" display: none;">N/A</label> <input type="radio" id="q_43-N/A" name="q_43" title="N/A" value="" checked="">
</td>
<td align="center" valign="middle" width="30%"> </td>
</tr>
</tbody>
</table>
</fieldset>
</td>
</tr>
</tbody>
</table>
<br><br>
<table cellspacing="0" cellpadding="0" style=" width:100%; margin: 0px 0 0 0; padding:0px; ">
<tbody>
<tr>
<td>
<table width="100%" style="border-top:none; border-left:none; border-right: none;">
<tbody>
<tr height="25">
<td width="40%" align="baseline"> </td>
<td align="center" valign="middle" width="10%">Excellent </td>
<td align="center" valign="middle" width="10%">Good </td>
<td align="center" valign="middle" width="10%">OK</td>
<td align="center" valign="middle" width="10%">Poor </td>
<td align="center" valign="middle" width="10%">Awful </td>
<td align="center" valign="middle" width="10%">N/A </td>
</tr>
</tbody>
</table>
<fieldset title="Facility Appearance" style=" border: none;">
<table style="width:100%; cellpadding:5px 0 5px 0px; border:none;" border="0" cellspacing="0">
<tbody>
<tr height="25px" bgcolor="EAEAEA">
<td style="font-size : auto;padding:7px;font-style : bold; line-height: 1.3;font-weight : lighter; width: inherit; height:25; ">
<div id="o_38" style="font-weight:500; border:none;">Facility Appearance</div>
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_38-Excellent" style=" display: none;">Excellent</label> <input type="radio" id="q_38-Excellent" name="q_38" title="Excellent" value="5">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_38-Good" style=" display: none;">Good</label> <input type="radio" id="q_38-Good" name="q_38" title="Good" value="4">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_38-OK" style=" display: none;">OK</label> <input type="radio" id="q_38-OK" name="q_38" title="OK" value="3">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_38-Poor" style=" display: none;">Poor</label> <input type="radio" id="q_38-Poor" name="q_38" title="Poor" value="2">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_38-Awful" style=" display: none;">Awful</label> <input type="radio" id="q_38-Awful" name="q_38" title="Awful" value="1">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_38-N/A" style=" display: none;">N/A</label> <input type="radio" id="q_38-N/A" name="q_38" title="N/A" value="" checked="">
</td>
</tr>
</tbody>
</table>
</fieldset>
<fieldset title="How satisfied were you with group 1:1 education?" style=" border: none;">
<table style="width:100%; cellpadding:5px 0 5px 0px; border:none;" border="0" cellspacing="0">
<tbody>
<tr height="25px" bgcolor="dododo">
<td style="font-size : auto;padding:7px;font-style : bold; line-height: 1.3;font-weight : lighter; width: inherit; height:25; ">
<div id="o_210745" style="font-weight:500; border:none;">How satisfied were you with group 1:1 education?</div>
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210745-Excellent" style=" display: none;">Excellent</label> <input type="radio" id="q_210745-Excellent" name="q_210745" title="Excellent" value="5">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210745-Good" style=" display: none;">Good</label> <input type="radio" id="q_210745-Good" name="q_210745" title="Good" value="4">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210745-OK" style=" display: none;">OK</label> <input type="radio" id="q_210745-OK" name="q_210745" title="OK" value="3">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210745-Poor" style=" display: none;">Poor</label> <input type="radio" id="q_210745-Poor" name="q_210745" title="Poor" value="2">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210745-Awful" style=" display: none;">Awful</label> <input type="radio" id="q_210745-Awful" name="q_210745" title="Awful" value="1">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210745-N/A" style=" display: none;">N/A</label> <input type="radio" id="q_210745-N/A" name="q_210745" title="N/A" value="" checked="">
</td>
</tr>
</tbody>
</table>
</fieldset>
<fieldset title="How satisfied were you with food quality (i.e. taste, temperature, etc.)?" style=" border: none;">
<table style="width:100%; cellpadding:5px 0 5px 0px; border:none;" border="0" cellspacing="0">
<tbody>
<tr height="25px" bgcolor="EAEAEA">
<td style="font-size : auto;padding:7px;font-style : bold; line-height: 1.3;font-weight : lighter; width: inherit; height:25; ">
<div id="o_210746" style="font-weight:500; border:none;">How satisfied were you with food quality (i.e. taste, temperature, etc.)?</div>
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210746-Excellent" style=" display: none;">Excellent</label> <input type="radio" id="q_210746-Excellent" name="q_210746" title="Excellent" value="5">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210746-Good" style=" display: none;">Good</label> <input type="radio" id="q_210746-Good" name="q_210746" title="Good" value="4">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210746-OK" style=" display: none;">OK</label> <input type="radio" id="q_210746-OK" name="q_210746" title="OK" value="3">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210746-Poor" style=" display: none;">Poor</label> <input type="radio" id="q_210746-Poor" name="q_210746" title="Poor" value="2">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210746-Awful" style=" display: none;">Awful</label> <input type="radio" id="q_210746-Awful" name="q_210746" title="Awful" value="1">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210746-N/A" style=" display: none;">N/A</label> <input type="radio" id="q_210746-N/A" name="q_210746" title="N/A" value="" checked="">
</td>
</tr>
</tbody>
</table>
</fieldset>
<fieldset title="How satisfied were you with food options?" style=" border: none;">
<table style="width:100%; cellpadding:5px 0 5px 0px; border:none;" border="0" cellspacing="0">
<tbody>
<tr height="25px" bgcolor="dododo">
<td style="font-size : auto;padding:7px;font-style : bold; line-height: 1.3;font-weight : lighter; width: inherit; height:25; ">
<div id="o_210747" style="font-weight:500; border:none;">How satisfied were you with food options?</div>
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210747-Excellent" style=" display: none;">Excellent</label> <input type="radio" id="q_210747-Excellent" name="q_210747" title="Excellent" value="5">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210747-Good" style=" display: none;">Good</label> <input type="radio" id="q_210747-Good" name="q_210747" title="Good" value="4">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210747-OK" style=" display: none;">OK</label> <input type="radio" id="q_210747-OK" name="q_210747" title="OK" value="3">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210747-Poor" style=" display: none;">Poor</label> <input type="radio" id="q_210747-Poor" name="q_210747" title="Poor" value="2">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210747-Awful" style=" display: none;">Awful</label> <input type="radio" id="q_210747-Awful" name="q_210747" title="Awful" value="1">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_210747-N/A" style=" display: none;">N/A</label> <input type="radio" id="q_210747-N/A" name="q_210747" title="N/A" value="" checked="">
</td>
</tr>
</tbody>
</table>
</fieldset>
<fieldset title="Employee/Staff Attitude" style=" border: none;">
<table style="width:100%; cellpadding:5px 0 5px 0px; border:none;" border="0" cellspacing="0">
<tbody>
<tr height="25px" bgcolor="EAEAEA">
<td style="font-size : auto;padding:7px;font-style : bold; line-height: 1.3;font-weight : lighter; width: inherit; height:25; ">
<div id="o_39" style="font-weight:500; border:none;">Employee/Staff Attitude</div>
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_39-Excellent" style=" display: none;">Excellent</label> <input type="radio" id="q_39-Excellent" name="q_39" title="Excellent" value="5">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_39-Good" style=" display: none;">Good</label> <input type="radio" id="q_39-Good" name="q_39" title="Good" value="4">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_39-OK" style=" display: none;">OK</label> <input type="radio" id="q_39-OK" name="q_39" title="OK" value="3">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_39-Poor" style=" display: none;">Poor</label> <input type="radio" id="q_39-Poor" name="q_39" title="Poor" value="2">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_39-Awful" style=" display: none;">Awful</label> <input type="radio" id="q_39-Awful" name="q_39" title="Awful" value="1">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_39-N/A" style=" display: none;">N/A</label> <input type="radio" id="q_39-N/A" name="q_39" title="N/A" value="" checked="">
</td>
</tr>
</tbody>
</table>
</fieldset>
<fieldset title="Timeliness of Service" style=" border: none;">
<table style="width:100%; cellpadding:5px 0 5px 0px; border:none;" border="0" cellspacing="0">
<tbody>
<tr height="25px" bgcolor="dododo">
<td style="font-size : auto;padding:7px;font-style : bold; line-height: 1.3;font-weight : lighter; width: inherit; height:25; ">
<div id="o_40" style="font-weight:500; border:none;">Timeliness of Service</div>
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_40-Excellent" style=" display: none;">Excellent</label> <input type="radio" id="q_40-Excellent" name="q_40" title="Excellent" value="5">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_40-Good" style=" display: none;">Good</label> <input type="radio" id="q_40-Good" name="q_40" title="Good" value="4">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_40-OK" style=" display: none;">OK</label> <input type="radio" id="q_40-OK" name="q_40" title="OK" value="3">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_40-Poor" style=" display: none;">Poor</label> <input type="radio" id="q_40-Poor" name="q_40" title="Poor" value="2">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_40-Awful" style=" display: none;">Awful</label> <input type="radio" id="q_40-Awful" name="q_40" title="Awful" value="1">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_40-N/A" style=" display: none;">N/A</label> <input type="radio" id="q_40-N/A" name="q_40" title="N/A" value="" checked="">
</td>
</tr>
</tbody>
</table>
</fieldset>
<fieldset title="Hours of Service" style=" border: none;">
<table style="width:100%; cellpadding:5px 0 5px 0px; border:none;" border="0" cellspacing="0">
<tbody>
<tr height="25px" bgcolor="EAEAEA">
<td style="font-size : auto;padding:7px;font-style : bold; line-height: 1.3;font-weight : lighter; width: inherit; height:25; ">
<div id="o_42" style="font-weight:500; border:none;">Hours of Service</div>
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_42-Excellent" style=" display: none;">Excellent</label> <input type="radio" id="q_42-Excellent" name="q_42" title="Excellent" value="5">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_42-Good" style=" display: none;">Good</label> <input type="radio" id="q_42-Good" name="q_42" title="Good" value="4">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_42-OK" style=" display: none;">OK</label> <input type="radio" id="q_42-OK" name="q_42" title="OK" value="3">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_42-Poor" style=" display: none;">Poor</label> <input type="radio" id="q_42-Poor" name="q_42" title="Poor" value="2">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_42-Awful" style=" display: none;">Awful</label> <input type="radio" id="q_42-Awful" name="q_42" title="Awful" value="1">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_42-N/A" style=" display: none;">N/A</label> <input type="radio" id="q_42-N/A" name="q_42" title="N/A" value="" checked="">
</td>
</tr>
</tbody>
</table>
</fieldset>
<table width="100%" style="border-top:none; border-left:none; border-right: none;">
<tbody>
<tr height="40">
<td width="40%" align="baseline"> </td>
<td align="center" valign="bottom" width="10%">Yes </td>
<td align="center" valign="bottom" width="10%">No </td>
<td align="center" valign="bottom" width="10%">N/A</td>
<td align="center" valign="middle" width="30%"> </td>
</tr>
</tbody>
</table>
<fieldset title="Did the product or service meet your needs?" style=" border: none;">
<table style="width:100%; cellpadding:5px 0 5px 0px; border:none;" border="0" cellspacing="0">
<tbody>
<tr height="25px" bgcolor="dododo">
<td style="font-size : auto;padding:7px;font-style : bold; line-height: 1.3;font-weight : lighter; width: inherit; height:25; ">
<div id="o_300" style="font-weight:500; border:none;">Did the product or service meet your needs?</div>
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_300-Yes" style=" display: none;">Yes</label> <input type="radio" id="q_300-Yes" name="q_300" title="Yes" value="1">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_300-No" style=" display: none;">No</label> <input type="radio" id="q_300-No" name="q_300" title="No" value="0">
</td>
<td align="center" valign="middle" style="padding-top: 5px;" width="10%">
<label for="q_300-N/A" style=" display: none;">N/A</label> <input type="radio" id="q_300-N/A" name="q_300" title="N/A" value="" checked="">
</td>
<td align="center" valign="middle" width="30%"> </td>
</tr>
</tbody>
</table>
</fieldset>
</td>
</tr>
</tbody>
</table>
<br><br>
</section>
<input type="hidden" name="question_list" value="q_43,q_38,q_210745,q_210746,q_210747,q_39,q_40,q_42,q_300">
<input type="hidden" id="text_to_validate" name="text_to_validate" value="comments">
<section style=" background-color:#FFFFFF; padding: 10px; border-bottom:solid silver thin; margin-bottom: 0px; margin-left: 0px; title=" provide="" comments,="" contact="" information,="" submit="" card="" button"="">
<section style=" background-color:#F3F3F3; font-size:1em; margin-left: 0px; line-height:1.2; letter-spacing:1.2; font-family: verdana;">
<div style="margin:0 20px 20px 20px; ">
<span style="font-size:1em; line-height:2; font-family: sans-serif;"><label for="comments"> Comments & Recommendations for Improvement:</label></span>
<textarea class="std_textarea" name="comments" pattern="^[a-zA-Z0-9\-\s\,\(\)\/\&\'\_]*$" style="font-family: sans-serif; width: 99%;" wrap="virtual" id="comments" maxlength="4000" onkeyup="countChar(this.form)"
onchange="clear_msg(this.form)" onblur="validateText(this.form)"
placeholder="CAUTION: Do NOT enter sensitive or personally identifying information in this text field. By providing comment information in the text comment box, you are acknowledging that the information provided may be reviewed throughout the organization to which the comment was submitted and possibly at higher organization levels within the ICE system."></textarea>
<span style="font-size:1em; float:right; margin-right:10px;"><span id="chr_cnt">0</span>/4000</span><br>
</div>
<br>
<div style="margin: 0 0 0 6%;">
<input type="Checkbox" class="lg_checkbox" name="responseRequested" value="1" id="responseRequested" onclick="allowSubmit(this.form)"> <label for="responseRequested">Request a Response</label>
<br><br>
<div style="valign: bottom; padding-left:15px;font-size:small;"> *If you would like a response, please check the Request a Response checkbox above and enter your contact information below. </div>
</div>
<br><br>
<div align="center" style="margin: 0 0 0 5%; padding-right: 1px;">
<table style=" line-height: 2; padding-left: 0; width:90%; " cellspacing="5px">
<tbody>
<tr>
<td>
<label for="customer">Name: </label><span id="name_opt" style="font-size:.8em; "> (optional)</span><br>
<input type="text" name="customer" pattern="^[a-zA-Z0-9\.\ ]*$" title="Letters only" size="30" maxlength="75" id="customer" class="lg_input" style=" height: 26px;"><span id="name_msg" style="font-size:16pt; color:red;"> </span><br>
</td>
<td>
<label for="phone">Phone:</label><span id="phone_opt" style="font-size:.8em; "> (optional)</span><br>
<input type="tel" name="phone" size="30" maxlength="50" id="phone" title="555-5555 or (555)5555555 or 5555555555" class="lg_input" style=" height: 26px;" pattern="^[0-9\-\(\)]{7,16}$" placeholder=""
onfocus="clear_msg(this.form)"><span id="phone_msg" style="font-size:16pt; color:red;"> </span><br>
</td>
</tr>
<tr>
<td>
<label for="email">Email: </label><span id="email_opt" style="font-size:.8em;"> (optional)</span><br>
<input type="email" name="email" size="30" maxlength="100" id="email" title="your.name@test.mil" class="lg_input" style=" height: 26px;" onfocus="clear_msg(this.form)" placeholder=""><span id="email_msg"
style="font-size:16pt; color:red;"> </span><br>
</td>
<td>
<label for="reference">Reference Number:</label><span id="ref_opt" style="font-size:.8em;"> (optional)</span><br>
<input type="text" name="reference" size="30" maxlength="75" id="reference" title="Ticket or Request number" class="lg_input" style=" height: 26px; " pattern="^[0-9a-zA-Z\-\s]*$"><span id="ref_msg" style="font-size:16pt; color:red;">
</span><br>
</td>
</tr>
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<b>Agency Disclosure Notice:</b>The public reporting burden for this collection of information, OMB 0704-0420, is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services,
at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if
it does not display a currently valid OMB control number.
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<p align="center" style=" line-height: 1.5; font-size: 1.2em; max-height: 999px; width:90%; margin-left:5%;"> "Thank you for taking the time to complete this comment card. Your opinions are very important to us."<br><br>
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* HOME * About ICE * FAQ * Webmaster * Manager Login (CAC required) Home » Joint Base Elmendorf-Richardson » Health » Comment Card JBER HOSPITAL - BEHAVIOR HEALTH INPATIENT UNIT OMB 0704-0420, expires 30 Apr 2024 RCS DD-CMO(AR)2124, expires 30 APR 2026 JBER HOSPITAL - BEHAVIOR HEALTH INPATIENT UNIT COMMENT CARD COVID-19 (coronavirus) related information SHOULD NOT be submitted to services on ICE unless it is directly related to the service the customer received. General COVID-19 related feedback should be directed to resources outside of the ICE system that are dedicated to receive such info. Thank you for using ICE to give us your feedback! The ICE Customer application is intended for customers of Joint Base Elmendorf-Richardson (JBER) services to provide feedback (comments and/or ratings) about the products and services that they have utilized. For employee complaints/gripes about management or other employee within your unit, please use the chain of command. Privacy Advisory: If all fields are completed, this form contains personally identifiable information and is protected in accordance with the Privacy Act of 1974, as amended, DoD 5400.11-R and DoD Privacy Program. Yes No N/A Were you satisfied with your overall experience? Yes No N/A Excellent Good OK Poor Awful N/A Facility Appearance Excellent Good OK Poor Awful N/A How satisfied were you with group 1:1 education? Excellent Good OK Poor Awful N/A How satisfied were you with food quality (i.e. taste, temperature, etc.)? Excellent Good OK Poor Awful N/A How satisfied were you with food options? Excellent Good OK Poor Awful N/A Employee/Staff Attitude Excellent Good OK Poor Awful N/A Timeliness of Service Excellent Good OK Poor Awful N/A Hours of Service Excellent Good OK Poor Awful N/A Yes No N/A Did the product or service meet your needs? Yes No N/A Comments & Recommendations for Improvement: 0/4000 Request a Response *If you would like a response, please check the Request a Response checkbox above and enter your contact information below. Name: (optional) Phone: (optional) Email: (optional) Reference Number: (optional) Agency Disclosure Notice:The public reporting burden for this collection of information, OMB 0704-0420, is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. "Thank you for taking the time to complete this comment card. Your opinions are very important to us." * Intended Usage Advisory * Accessibility Statement * External Link Disclaimer * Privacy and Security Notice * No FEAR Act * Freedom of Information Act * Section 508 * USA.gov * Department of Defense * The White House * GSA