Website Consumer Satisfaction Survey

Please help us serve you and others better by completing our Web Site Customer Satisfaction Survey. Answering the questions below should only take a few minutes. Your participation is completely voluntary and will help us ensure that our Web site is useful, accurate, and complete. If you have any questions about how we will use this information, please review our Privacy Policy.

Fields marked with an asterisk (*) are mandatory.

*What were you looking for on our Web site? (Required)

Did you find what you were looking for? (1 = Very Useful, 5 = Not At All)
1 2 3 4 5

How useful is the information you found? (1 = Very Useful, 5 = Not At All)
1 2 3 4 5

Did you find our site easy to navigate? (1 = Very Useful, 5 = Not At All)
1 2 3 4 5

In general, how satisfied are you with the information provided? (1 = Very Useful, 5 = Not At All)

Clarity of the writing. (readability, ease of interpretation)
1 2 3 4 5

Relevance to your needs.
1 2 3 4 5

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Cell Phone Number:

E-mail Address:

Please provide additional comments and/or suggestions regarding ACP's about the Web site:
(Do not use this comment box to submit questions. We cannot reply to question you submit through the survey form. If you have a question, please refer to the top of this page for methods of contacting us.)

Notice on Collection of Personal Information
Collection and Use of Personal Information. The Arbitration Certification Program of the Department of Consumer Affairs collects the information requested on this form as authorized by Business and Professions Code Sections 325 and 326. The Department uses this information to follow up on your survey comments.

Providing Personal Information Is Voluntary. You do not have to provide the personal information requested. If you do not wish to provide personal information, such as your name, home address, or home telephone number, you may remain anonymous. In that case, however, we may not be able to contact you regarding your survey comments.

Access to Your Information. You may review the records maintained by the Department that contain your personal information, as permitted by the Information Practices Act. See below for contact information.

Possible Disclosure of Personal Information.
We make every effort to protect the personal information you provide us. In order to follow up on your survey comments, however, we may need to share the information you give us with the business you complained about or with other government agencies. This may include sharing any personal information you gave us.

The information you provide may also be disclosed in the following circumstances:

In response to a Public Records Act request, as allowed by the Information Practices Act;
To another government agency as required by state or federal law; or
In response to a court or administrative order, a subpoena, or a search warrant.

Contact Information. For questions about this notice, the Department's Privacy Policy, or access to your records, you may contact the Information Security Office in the Department of Consumer Affairs, 1625 North Market Blvd., Suite S202, Sacramento, CA 95834, or email dca@dca.ca.gov.

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