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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
 
 
 
How would you rate your overall level of satisfaction with us?
 
Highly satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Highly dissatisfied
 
Comment:
 
 
 
What is your overall satisfaction with the newsletter?
 
Very satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Very dissatisfied
 
 
 
How relevant do you find the information in the newsletter?
 
Very relevant
 
Somewhat relevant
 
Neutral
 
Somewhat irrelevant
 
Very irrelevant
 
 
 
How satisfied were you with your last interaction with our company?
 
Extremely satisfied
 
Slightly satisfied
 
Neither satisfied nor dissatisfied
 
Slightly dissatisfied
 
Extremely dissatisfied
 
 
 
How helpful is our company with your needs or questions?
 
Extremely helpful
 
Very helpful
 
Moderately helpful
 
Slightly helpful
 
Not at all helpful
 
 
 
In general, how satisfied are you with the employees you interacted with?
 
Extremely satisfied
 
Slightly satisfied
 
Neither satisfied nor dissatisfied
 
Slightly dissatisfied
 
Extremely dissatisfied
 
 
 
How well do the employees at our company protect your privacy?
 
Extremely well
 
Very well
 
Moderately well
 
Slightly well
 
Not at all well
 
 
 
How long did you have to wait before a customer service representative was able to help you?
 
Extremely long
 
Very long
 
Moderately long
 
Slightly long
 
Not at all long
 
 
 
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
 
 
 
What is the highest level of education you have achieved?
 
Less than high school degree
 
High school degree or equivalent (e.g. GED)
 
Some college but no degree
 
Associate degree (e.g. AA, AS)
 
Bachelor's degree (e.g. BA, AB, BS)
 
Master's degree (e.g. MA, MS, MBA)
 
Professional degree (e.g. MD, DDS, JD)
 
Doctorate degree (e.g. PhD)
 
 
 
How would you rate our concierge service?
 
Below standard
 
Insufficient
 
Satisfactory
 
Good
 
Excellent
 
 
 
How well did our staff respond to your needs?
 
Below standard
 
Insufficient
 
Satisfactory
 
Good
 
Excellent
 
 
 
How would you rate your server's knowledge of the menu?
 
Very unknowledgeable
 
Unknowledgeable
 
Neutral
 
Somewhat knowledgeable
 
Very knowledgeable
 
 
 
How prompt was your service?
 
Prompt
 
Not prompt
 
 
 
What are your reasons for joining our company? (Check all that apply)
 
Unemployed and needed a job
 
Referred by a friend
 
Fringe benefits
 
Reputation as a good place to work
 
Career advancement
 
Advertisement
 
Salary advancement
 
Other

 
 
 
If you have ever offered suggestions to management, how satisfied were you with the response?
 
Never offered a suggestion
 
Not at all satisfied
 
Not very satisfied
 
Somewhat satisfied
 
Very satisfied