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2012
December
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Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
I Agree
What is your gender?
Male
Female
What is your marital status?
Single (Never married)
Married
Domestic partnership
Widowed
Divorced
Separated
Don’t know
What is your age?
Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer
How long have you used our products?
Less than 6 months
6 months to less than 1 year
1 year to less than 3 years
3 years to less than 5 years
5 years or more
How frequently do you purchase from us?
Every day
Every week
Every 2 - 3 weeks
Every month
Every 2 - 3 months
Every 4 - 6 months
Once or twice a year
How would you rate your level of satisfaction with us?
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
Where do you purchase our products? Select all that apply.
In our store
Online
Telephone order/catalogue
Through a dealer
Through an agent
Through a wholesaler
Other
How would you rate your overall level of satisfaction with us?
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
Comment:
Have you ever recommended us to others?
No, never recommended
Have recommended once or twice
Have recommended several times
How do we rate in comparison to other companies that offer the same products?
Much higher
Somewhat higher
Same
Somewhat lower
Much lower
Don't know
How likely are you to continue doing business with us?
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
How likely you would recommend our products to a friend or colleague?
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
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