Claims Satisfaction Survey

First Name

Last Name

Claim Number

Date Claim Occurred

Please select a representative.

	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	Not Applicable
I was satisfied with how quickly the adjuster contacted me after I reported my claim.	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	Not Applicable
The reporting of my claim was easy and convenient	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	Not Applicable
I was satisfied with how quickly my automobile or home was inspected.	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	Not Applicable
I was satisfied with how quickly my claim was paid.	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	Not Applicable
Overall, my expectations were met.	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	Not Applicable

Additional Comments

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Would you like to be contacted?

Yes

Name of Contact

Contact name is required.

Phone Number

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Best Time to Call

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Reason for Contact

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East Street is a people-driven insurance company that’s focused on building open and honest relationships with customers.

5325 Deerfield Boulevard
Mason, OH 45040
Suite: #109