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What do you normally eat for breakfast?
 
Peanut butter and Jelly toast
 
Eggs
 
Cereal
 
Yogurt
 
Other
 
 
 
 
What do you normally eat for lunch?
 
Pasta
 
Salad
 
Sandwich
 
Soup
 
Pizza
 
Other
 
 
 
 
What do you normally eat for a snack?
 
Cookies
 
Chips
 
Fruit
 
Granola Bar
 
Chocolate
 
Other
 
 
 
 
What do you normally eat for dinner?
 
Meat potatoes and vegetables
 
Vegetables and rice
 
Fast food and restaurant
 
Tv dinners
 
 
 
Other
 
 
 
 
What do you normally drink?
 
Water
 
Soda pop
 
Juice
 
Milk
 
Other
 
 
 
How important were each of the following factors in your decision to purchase our product?
Very Unimportant Somewhat Unimportant Neutral Somewhat Important Very Important
Pricing
Ease of Use
Responsiveness of support staff
Quality
 
 
 
What does [COMPANY NAME] do that makes it unique from its competitors?
   
 
 
 
How long have you used our products?
 
For less than 1 month
 
For 1 to 6 months
 
For 7 months up to 1 year
 
For 1 to 2 years
 
For more than 2 years
 
 
 
How likely are you to do business with us again?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
Is there anything we could do to improve your experience as a customer?
   
 
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