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Questions marked with an * are required Exit Survey
 
 
Multiple Choice
 
 
Single Select Question
* Select One http://www.w3school.com
 
Saturday
 
Friday
 
Tuesday
 
Monday
 
Wednesday
 
Sunday
 
Thursday
 
Other
 
 
 
 
Select Many - Employment Status
 
Unemployed
 
Self-employed
 
Part-time
 
Full-time
 
Homemaker
 
Student
 
Retired
 
Military

 
 
 
Drop Down Menu
 
 
 
Open Ended Text
 
 
 
Comment Box - Multiple Rows
   
 
 
 
Comment Box - Single Row
   
 
 
 
Email Address
   
 
 
 
Age - Next To Question
Age of person is    years
 
 
Contact Info
First Name Edited : 
Last Name Edited : 
Address 1 Edited : 
Address 2 Edited : 
City Edited : 
State Edited : 
Zip Edited : 
Phone Edited : 
Email Address Edited : 
 
 
Multi Choice Matrix
Very unsatisfied Somewhat unsatisfied Slightly unsatisfied Neither satisfied nor unsatisfied Slightly satisfied Somewhat satisfied Very satisfied Other
Multi Choice Matrix - Website
Multi Choice Matrix - Customer Service
Multi Choice Matrix - Overall
 
 
Checkbox Matrix
Always Most of the time About half the time Once in a while Never Other
Checkbox Matrix - Website
Checkbox Matrix - Customer Service
Checkbox Matrix - Overall
 
 
Spreadsheet

Yes No
Spreadsheet - Website
Spreadsheet - Customer Service
Spreadsheet - Overall
 
 
 
Ordering
 
 
 
Drag N Drop
Drag your choices here to rank them
     
     
     
    Rank Order
    Skiing
    Snowboarding
    Biking
    Cricket
    Hockey
     
     
     
    Constant Sum
    Essentials (Gas, Grocery etc.)
    Rs
    ₹
    Entertainment (Movies, Clubs etc.)
    Rs
    ₹
    HAHAHA
    Rs
    ₹
    Other
    Rs
    ₹
    0
     
     
    Star Rating
    Star Rating - Books
    Star Rating - Movies
    Star Rating - Music
    Star Rating - Play
     
     
     
    Smiley Rating
    VU
    U
    N
    S
    VS
     
     
     
    Thumbs Up-Down
    Love it
    Hate it
     
     
     
    Image and Video
     
     
     
    Image Rating (Select One)
    Manchester United
    Chelsea
    Liverpool
    Arsenal
    Manchester City
     
     
     
    Image Rating (Select One)
    Manchester United
    Chelsea
    Liverpool
    Arsenal
    Manchester City
     
     
     
    Image Rating (Select Many)
    Manchester United
    Chelsea
    Arsenal
    Liverpool
    Manchester City

     
     
    Image Rating
    Manchester United
    Chelsea
    Liverpool
    Arsenal
    Manchester City
     
     
    Video Question
     
     
    Please rate your video - QuerstionPro
     
     
    TubePulse
     
    1
    10
     
     
       
       
      Push To Social
      Push To Social - Overall
       
       
       
      Date Time
       
       
       
      Date
      MonthDayYear
        
       
       
       
      TIME
      Hrs.Mins.AM/PM
        
       
       
       
      Date Time
      MonthDayYearHrs.Mins.AM/PM
          
       
       
       
      Calendar
       
       
       
      CAPTCHA
         
       
       
       
      Advance Matrix
       
       
       
      ImportanceSatisfactionPerformance
      Customer Service
      Product Packaging
      On-Time Arrival
       
       
      Complex Flex Matrix
      Matrix Table[Left,Right]Drop Down MenuMultiple Choice - Select ManyText Box
      MT1MT2MT3MT4
      Product Packaging
      On-Time Arrival
      Price
       
       
       
      Net Promoter Score
      «UnlikelyLikely»
      012345678910
       
       
       
      Slider Question
       
       
      Numeric Slider
      Numeric Slider - Website
      -
      Numeric Slider - Customer Service
      -
      Numeric Slider - Overall
      -
       
       
      Text Slider
      Always Most of the time About half the time Once in a while Never
      Text Slider - Website
      -
      Text Slider - Customer Service
      -
      Text Slider - Overall
      -
       
       
       
      QP MAPS
       
       
       
      Reference Data
       
       
       
      Lookup Table
       
       
      2-Tier Lookup Table
       
       
      * Zip Code
       
       
       
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      Signature
       
       
       
      Please scan QR code
       
       
       
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