Customer satisfaction level is an essential factor to attract and maintain customers, In western casino market, systematic approaches have long been studied and developed to aim at improving customer satisfaction level. However, the gaming operators in Macau still lag behind to employ a systematic approach to improve the customer satisfaction. Much more work is needed here to bridge the gap. In this research, Six Sigma approach will be employed to investigate the customer satisfaction in casinos at Macau. Managerial implications for the improvement of customer satisfaction level with Macau casinos are presented. It is expected that this research will lead to certain impact on local casino industries for the service quality they provided.