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How would you rate your overall level of satisfaction with us?
 
Highly dissatisfied
 
Somewhat dissatisfied
 
Neutral
 
Somewhat dissatisfied
 
Highly dissatisfied
 
 
Comment:
   
 
 
 
How do you usually purchase from us? Select all that apply.
 
Online
 
Physical store
 
By phone
 
By mail
 
Have not yet purchased

 
 
Please indicate the degree to which you agree or disagree with the following statements about our store.
Disagree completely Disagree somewhat Neutral Agree somewhat Agree completely N/A
The staff is professional
The staff is knowledgeable
The staff is helpful
The store offers a good variety of products
The store offers high quality products
The products are reasonably priced
 
 
Comments:
   
 
 
 
How long have you purchased from us?
 
Have not yet purchased
 
Less than 1 month
 
1 month to less than 6 months
 
6 months to less than 1 year
 
1 year to less than 3 years
 
3 years or more
 
 
 
How often do you purchase from us?
 
Weekly
 
Monthly
 
Once every 3 months
 
Once every 6 months
 
Once a year or less
 
Once a year or less
 
Have not yet purchased
 
 
 
Which of our products do you purchase? Select all that apply.
 
{PRODUCT 1}
 
{PRODUCT 2}
 
{PRODUCT 3}
 
{PRODUCT 4}
 
{PRODUCT 5}
 
Other
 

 
 
 
How likely are you to recommend us to a friend or colleague?
 
Very unlikely
 
Somewhat unlikely
 
Neutral
 
Somewhat likely
 
Highly likely
 
 
Comment:
   
 
 
 
Please provide suggestions for improvement.
   
 
 
 
What is your gender?
 
Female
 
Male
 
Prefer not to answer
 
 
 
Which category describes your age?
 
Under 18
 
18-24
 
25-34
 
35-44
 
45-54
 
55-65
 
Over 65
 
Prefer not to answer