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Overall, how would you rate [COMPANY]?
 
Excellent
 
Good
 
Average
 
Poor
 
Terrible
 
 
 
How satisfied are you with your service from [COMPANY]?
 
Extremely satisfied
 
Very satisfied
 
Neutral
 
Very dissatisfied
 
Extremely dissatisfied
 
 
 
Would you recommend [COMPANY] to a friend?
 
Yes
 
No
 
 
 
If no, why not?
   
 
 
 
For your NEXT [PRODUCT] purchase, how likely are you to purchase from [COMPANY]?
 
Very likely
 
Somewhat likely
 
Not sure
 
Somewhat unlikely
 
Very unlikely
 
 
 
What are the THREE main reasons you didn't purchase [PRODUCT] from [COMPANY]?
   
 
 
 
If you could change something about [COMPANY] what would it be?
   
 
 
 
Are there any other comments you have for [COMPANY]?
   
 
 
 
In thinking about your most recent experience with (Company Name), was the quailty of customer service you received:
 
Excellent
 
Good
 
Average
 
Poor
 
Very poor
 
 
 
If you were not totally satisfied with the customer service, please describe the reasons for your dissatisfaction.
   
 
 
 
Was the process for getting your question resolved:
 
Excellent
 
Good
 
Average
 
Poor
 
Very poor
 
 
 
If you were not totally satisfied with the process of getting your problem resolved, please describe the reasons for your dissatisfaction.
   
 
 
 
Would you say the value of the (Company product), as compared to its price, is:
 
Excellent
 
Good
 
Average
 
Poor
 
Very poor
 
 
 
How familiar are you with [PRODUCT]?
 
Never heard of it
 
I am aware but have never used it
 
Use it only sometimes
 
Use it on a regular basis
 
 
 
Which of these[GENERIC_PRODUCT] have you used?
 
[ENTER BRAND 1]
 
[ENTER BRAND 2]
 
[ENTER BRAND 3]
 
[ENTER BRAND 4]
 
[ENTER BRAND 5]
 
[ENTER BRAND6]
 
Other
 
 
 
 
How did you first hear about [PRODUCT]?
 
TV
 
Radio
 
Magazine
 
Newspaper
 
Internet
 
Friend/relative/associate
 
Haven't heard of it before
 
Not sure
 
Other
 
 
 
 
Overall, how do you rate the quality of [PRODUCT]?
 
Poor
 
Fair
 
Good
 
Very Good
 
Excellent
 
 
 
What is it that you would most like to change about [PRODUCT]?
   
 
 
 
Would you recommend [PRODUCT] to a friend or associate?
 
Definitely Not
 
Probably Not
 
Not sure
 
Probably
 
Definitely
 
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