Customer Satisfaction Survey

Hospital Name:

Your Name:

E-mail Address:

Telephone Number:

1. How likely is it that you would recommend this company to a colleague?

(0 = Not at all likely > 10 = Extremely likely)
012345678910

2. How would you rate our delivery performance?

—Please choose an option—Very satisfiedSomewhat satisfiedNeither satisfied nor dissatisfiedSomewhat dissatisfiedVery dissatisfied

3. Which of the following words would you use to describe our products? Select all that apply.

ReliableHigh qualityUsefulUniqueGood value for moneyOverpricedImpracticalIneffectivePoor qualityUnreliable

4. How well do our products meet your needs?

—Please choose an option—Extremely wellVery wellSomewhat wellNot so wellNot at all well

5. How would you rate the quality of the product?

—Please choose an option—Very high qualityHigh qualityNeither high nor low qualityLow qualityVery low quality

6. How would you rate the value for money of the product?

—Please choose an option—ExcellentAbove averageAverageBelow averagePoor

7. How responsive have we been to your questions or concerns about our products?

—Please choose an option—Extremely responsiveVery responsiveSomewhat responsiveNot so responsiveNot at all responsiveNot applicable

8. How long have you been a customer of our company?

—Please choose an option—This is my first purchaseLess than six monthsSix months to a year1 - 2 years3 or more yearsI haven't made a purchase yet

9. How likely are you to purchase any of our products again?

—Please choose an option—Extremely likelyVery likelySomewhat likelyNot so likelyNot at all likely

10. Do you have any other comments, questions, or concerns?

Would you like any further information on any of our products?