AC2 Client Satisfaction Survey

Your Details (optional)

First Names

Surname

Phone (for follow-up)

Email (for follow-up)

Please enter a valid email address.

About Your Visit

Service Used *

Please select the service you used.

Date of Visit

Rate Your Experience

Tap the stars to rate (1 = poor, 5 = excellent)

Cleanliness of the facility

⭐ ⭐ ⭐ ⭐ ⭐

Friendliness of staff

⭐ ⭐ ⭐ ⭐ ⭐

Quality of service received

⭐ ⭐ ⭐ ⭐ ⭐

Variety of services available

⭐ ⭐ ⭐ ⭐ ⭐

Your Comments

What did we do well? (optional)

How can we improve? (optional)

Would you recommend AC2 to others?

Privacy Notice (POPIA)

AC2 QueerCare collects this feedback to improve our services. Any personal information you provide (name, phone, email) is processed in accordance with the Protection of Personal Information Act (POPIA). Your data will not be shared with third parties and is used solely for service improvement and follow-up communication.

I understand and consent to AC2 QueerCare processing my feedback in accordance with POPIA. *

You must accept the privacy notice to submit.

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Thank you for your feedback!

Your response has been recorded. We truly appreciate you taking the time to help us improve our services for the community.

AC2 QueerCare — Block F, Unit 1 Hatfield Gardens, Pretoria

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