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In thinking about your most recent experience with the Vocational Rehab. Service how satisfied are you with the therapist who you saw
 
Very satisfied
 
Satisfied
 
Neutral
 
Dissatisfied
 
Very dissatisfied
 
N/A
 
 
 
If you were not totally satisfied with the therapist, will you please describe the reason(s) for your dissatisfaction?
   
 
 
 
Will you please describe the aspects of the service that you were completely satisfied with?
   
 
 
 
How satisfied are you with the process of getting you back to work
 
Very satisfied
 
Satisfied
 
Neutral
 
Dissatisfied
 
Very dissatisfied
 
 
 
If you were not totally satisfied with the process of getting back to work, will you please take a few minutes and describe the reason(s) for your dissatisfaction?
   
 
 
 
If you were satisfied with the process of getting back to work, will you please take a few minutes and describe the reason(s) for your satisfaction?
   
 
 
 
How would you rate the therapist who worked with you
 
Excellent
 
Good
 
Fair
 
Poor
 
Not sure
 
 
 
What aspects of the therapy were of no benifite to you?
   
 
 
 
What aspects of the therapy were most beneficial for you?
   
 
 
 
Please choose an option that closely represents your opinion about the therapist you saw.
 
 
 
The Occupational Therapist was very courteous.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
 
 
The Occupational Therapist worked with me in a timely manner.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
 
 
The Occupational Therapist was very knowledgeable.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
 
 
Please choose an option that closely represents your opinion about the process you went through with this service.
 
 
 
The waiting time for having my questions addressed was satisfactory.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
 
 
My phone call was quickly transferred to the person who best could answer my question.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
 
 
The automated phone system made the customer service experience more satisfying.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
 
 
Consider if you would the total package i.e. [COMPANY] customer service, [PRODUCT] features and benefits, and cost. How satisfied are you with the [COMPANY]?
 
Very Satisfied
 
Satisfied
 
Neutral
 
Dissatisfied
 
Very Dissatisfied
 
 
 
If the [PRODUCT] were no longer manufactured by [COMPANY], what would you replace it with?
 
Funtional Competitor 1
 
Functional Competitor 2
 
Functional Competitor 3
 
In-Kind Competitor 1
 
In-Kind Competitor 2
 
In-Kind Competitor 3
 
Other
 
 
 
 
All things considered, over the next 12 months how likely are you to replace [COMPANY_PRODUCT] with [COMPETITOR_PRODUCT]?
 
Very certain
 
High chance
 
Low chance
 
No chance
 
Not sure
 
 
 
What are some of the reasons that you are looking to replace [COMPANY_PRODUCT] some time this year?
   
 
Vocational Rehab. service
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