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How many times have you used our services in the past year?
 
None
 
1 - 2
 
3 - 4
 
5 or more
 
 
 
When was the last time you did business with us?
 
Within the last month
 
Between 1 and 3 months ago
 
Between 3 and 6 months ago
 
Between 6 months and a year ago
 
More than a year ago
 
Never done business with us
 
 
 
What specific services did you use during your last experience with us? Select all that apply.
 
{SERVICE 1}
 
{SERVICE 2}
 
{SERVICE 3}
 
{SERVICE 4}
 
{SERVICE 5}

 
 
How important are each of the following factors when shopping for {SERVICE NAME}? Please rank in order of importance.
Least Important Most Important
{FEATURE 1}
{FEATURE 2}
{FEATURE 3}
{FEATURE 4}
{FEATURE 5}
 
 
 
How much time did you spend interacting with a representative?
 
I did not interact with a representative
 
Up to 5 minutes
 
Between 5 to 15 minutes
 
Between 15 to 30 minutes
 
Between 30 to 60 minutes
 
More than 60 minutes
 
 
 
Have you ever used any of the following services? Select all that apply.
 
{SERVICE 1}
 
{SERVICE 2}
 
{SERVICE 3}
 
{SERVICE 4}
 
{SERVICE 5}

 
 
 
How likely is it that you will do business with us again?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
Do you have any suggestions for improving our services? If so, what?