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How long have you used our [PRODUCTS/SERVICES]?
 
Less than 6 months
 
6 months to less than 1 year
 
1 year to less than 3 years
 
3 years to less than 5 years
 
5 years or more
 
 
 
Which of our [PRODUCTS/SERVICES] do you use? Select all that apply.
 
{OPTION 1}
 
{OPTION 2}
 
{OPTION 3}
 
{OPTION 4}
 
{OPTION 5}

 
 
 
How frequently do you purchase from us?
 
Every day
 
Every week
 
Every 2 - 3 weeks
 
Every month
 
Every 2 - 3 months
 
Every 4 - 6 months
 
Once or twice a year
 
 
 
How would you rate your level of satisfaction with us?
 
Highly satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Highly dissatisfied
 
 
How much do you rate us on the following attributes?
Well Below Average Below Average Average Above Average Well Above Average
Customer service
Professionalism
Quality of {PRODUCTS/SERVICES}
Understanding customers' needs
Sales staff
Price
 
 
Comment:
   
 
 
 
How likely are you to continue doing business with us?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
How likely is it that you would recommend our [PRODUCTS/SERVICES] to a friend or colleague?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
Do you have any suggestions for improving our [PRODUCTS/SERVICES]?
   
 
 
 
What is your gender?
 
Male
 
Female
 
Prefer not to answer
 
 
 
Which category describes your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
What best describes your employment status?
 
Employed full-time
 
Employed part-time
 
Self-employed
 
Not employed, but looking for work
 
Not employed, not looking for work
 
Retired
 
Student
 
Military
 
Homemaker
 
Prefer not to answer
 
Other
 
 
 
 
Which of the following categories best describes the industry you work in?
 
Automotive
 
Advertising
 
Consulting Services
 
Education
 
Entertainment
 
Financial Services
 
Government Services
 
Healthcare
 
Human Resources
 
Information Technology
 
Marketing/Sales
 
Non-Profit
 
Pharmaceuticals
 
Public Relations
 
Technical Services
 
Travel
 
Other
 
 
 
 
Which category best describes your annual income?
 
Under $15,000
 
$15,000 - $29,999
 
$30,000 - $44,999
 
$45,000 - $59,999
 
$60,000 - $74,999
 
$75,000 - $89,999
 
$90,000 or more
 
Prefer not to answer
 
 
 
Overall, I am very satisfied with the way [COMPANY] performed (is performing) on this project.
 
Strongly disagree
 
Somewhat disagree
 
Neutral
 
Somewhat agree
 
Strongly agree
 
N/A
 
 
 
Strongly Disagree Somewhat Disagree Neutral Somewhat Agree Strongly Agree N/A
service representatives are well trained. COMPANY
service representatives are well supervised. COMPANY
service representatives adhere to professional standards of conduct. COMPANY
service representatives act in my best interest. COMPANY
Overall, I am satisfied with the service representatives. COMPANY
 
 
 
Strongly Disagree Somewhat Disagree Neither Agree or Disagree Somewhat Agree Strongly Agree N/A
The account manager is knowledgeable and professional. COMPANY
I feel like I have a good personal relationship with the account manager. COMPANY
The account manager is making a positive contribution to my business. COMPANY
The account manager responds to my inquiries in a timely manner. COMPANY
Overall, I am very satisfied with the account manager. COMPANY
 
 
 
Compared to how you felt about [COMPANY] before this project, what would you say is the likelihood of completing another project with [COMPANY] now?
 
Better, based on performance
 
About the same
 
Worse, based on performance
 
Not sure
 
 
 
Considering the overall value of the project you paid for, was it
 
An exceptional value, worth more than you paid for it
 
A good value, worth about what you paid for it
 
A poor value, worth less than you paid for it
 
Not sure
 
 
 
In your most recent customer service experience, how did you contact the representative?

 
In Person
 
By Telephone
 
Internet
 
Through a Dealer/Retailer/Broker
 
Other
 
 
 

Strongly Agree Agree Neutral Disagree Strongly Disagree
Sufficient information was available on the internet to solve my problem.
 
 
 
About how long did you have to wait before speaking to a representative?
 
I was taken care of immediately
 
Within 3 minutes
 
3-5 minutes
 
5-10 minutes
 
More than 10 minutes
 
 
 
Did our representative... (Select all that apply)



 
Quickly identify the problem
 
Appear knowledgeable and competent
 
Help you understand the cause and the solution to the problem
 
Handle issues with courtesy and professionalism

 
 
 
About how long did it take to get this problem resolved?
 
Immediate Resolution
 
Less than a day
 
Between 2 and 3 days
 
Between 3 and 5 days
 
More than a week
 
The problem is still not resolved
 
 
 
How many times did you have to contact customer service before the problem was corrected?
 
Once
 
Twice
 
Three Times
 
More than Three times
 
 

Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied
Overall, how satisfied are you with the customer service experience?
 
 
In evaluating your most recent customer service experience, was the quality of service you received:
 
Very poor
 
Somewhat unsatisfactory
 
About average
 
Very satisfactory
 
Superior
 
 
 
The process of getting your problem resolved was:
 
Very poor
 
Somewhat unsatisfactory
 
About average
 
Very satisfactory
 
Superior
 
 
Customer Service Representative
The customer service representative as very courteous.
 
Strongly disagree
 
Somewhat disagree
 
Neutral
 
Somewhat agree
 
Strongly agree
 
 
 
Which of the following qualities of the service representative stood out (as being superior)?
 
Patient
 
Enthusiastic
 
Listened carefully
 
Friendly
 
Responsive
 
Other
 
 
 
What qualities of the customer service representative irked you?
 
Not patient
 
Not enthusiastic
 
Didn't listen carefully
 
Unfriendly
 
Unresponsive
 
Other
 
No qualities irked me
 
 
 
The customer service representative handled my call quickly.
 
Strongly disagree
 
Somewhat disagree
 
Neutral
 
Somewhat agree
 
Strongly agree
 
 
 
What would best describe your experience, when you called?
 
Kept me waiting on hold
 
Had to explain several times
 
Didn't know how to handle problem
 
Had to ask others
 
Spoke slowly
 
Other
 
No improvement needed
 
 
 
The customer service representative was very knowledgeable.
 
Strongly disagree
 
Somewhat disagree
 
Neutral
 
Somewhat agree
 
Strongly agree
 
 
 
The customer service:
 
Gave me the wrong information
 
Didn't understand the question
 
Gave unclear answers
 
Couldn't solve problem
 
Disorganized
 
Other
 
No improvement needed
 
 
 
The waiting time for having my question addressed was satisfactory.
 
Strongly disagree
 
Somewhat disagree
 
Neutral
 
Somewhat agree
 
Strongly agree
 
 
 
My phone call was quickly transferred to the person who could best assist me:
 
Strongly disagree
 
Somewhat disagree
 
Neutral
 
Somewhat agree
 
Strongly agree
 
 
 
Over the next 12 months, how likely are you to replace your (product) with another (product or brand)?
 
Certain
 
High chance
 
Equal chance
 
Low chance
 
Never
 
 
 
In thinking about your most recent experience with [COMPANY], was the quality of customer service you received:
 
Very Poor
 
Somewhat Unsatisfactory
 
About Average
 
Very Satisfactory
 
Superior
 
 
Customer Service Representative


The following questions pertain to the customer service representative you spoke with most recently. Please indicate whether you agree or disagree with the following statements
Strongly Agree Agree Neutral Disagree Strongly Disagree
The customer service representative was very courteous
The customer service representative handled my call quickly
The customer service representative was very knowledgeable
 
The Process


The following questions pertain to the process by which your most recent service contract was handled. Please indicate whether you agree or disagree with the following statements.
Strongly Agree Agree Neutral Disagree Strongly Disagree
The waiting time for having my questions addressed was satisfactory
My phone call was quickly transferred to the person who best could answer my question
The automated phone system made the customer service experience more satisfying
 
 

Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied
Considering the total package offered by including customer service, [PRODUCT] features and benefits, and cost; how satisfied are you with [COMPANY]? COMPANY
 
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