Customer Experience SurveyCustomer Experience Survey

1. Please tell us a little about yourself.

Please tell us a little about yourself. Name:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

2. Please indicate your gender.

Please indicate your gender. Male

Female

3. Which range includes your age?

Which range includes your age? Younger than 18

18-24

25-34

35-44

45-54

55 and older

Prefer not to answer

4. How long have you used our products/services?

How long have you used our products/services? Less than 1 year

Between 1 & 2 years

Between 2 & 3 years

Greater than 3 years

5. Why did you visit/contact our location?

Why did you visit/contact our location?

6. Please rate the following on a scale of 1-5

	Very satisfied	Somewhat satisfied	Neither Satisfied nor dissatisfied	Somewhat dissatisfied	Very dissatisfied
How would you rate the overall service quality of the service you received?	*Please rate the following on a scale of 1-5 How would you rate the overall service quality of the service you received? Very satisfied	How would you rate the overall service quality of the service you received? Somewhat satisfied	How would you rate the overall service quality of the service you received? Neither Satisfied nor dissatisfied	How would you rate the overall service quality of the service you received? Somewhat dissatisfied	How would you rate the overall service quality of the service you received? Very dissatisfied
How would you rate the care representative who assisted you today?	How would you rate the care representative who assisted you today? Very satisfied	How would you rate the care representative who assisted you today? Somewhat satisfied	How would you rate the care representative who assisted you today? Neither Satisfied nor dissatisfied	How would you rate the care representative who assisted you today? Somewhat dissatisfied	How would you rate the care representative who assisted you today? Very dissatisfied
How would you rate the knowledge and competence of the employee who assisted you today?	How would you rate the knowledge and competence of the employee who assisted you today? Very satisfied	How would you rate the knowledge and competence of the employee who assisted you today? Somewhat satisfied	How would you rate the knowledge and competence of the employee who assisted you today? Neither Satisfied nor dissatisfied	How would you rate the knowledge and competence of the employee who assisted you today? Somewhat dissatisfied	How would you rate the knowledge and competence of the employee who assisted you today? Very dissatisfied
How effective was our staff at resolving your issue?	How effective was our staff at resolving your issue? Very satisfied	How effective was our staff at resolving your issue? Somewhat satisfied	How effective was our staff at resolving your issue? Neither Satisfied nor dissatisfied	How effective was our staff at resolving your issue? Somewhat dissatisfied	How effective was our staff at resolving your issue? Very dissatisfied
How satisfied were you with the solution that was provided to you today?	How satisfied were you with the solution that was provided to you today? Very satisfied	How satisfied were you with the solution that was provided to you today? Somewhat satisfied	How satisfied were you with the solution that was provided to you today? Neither Satisfied nor dissatisfied	How satisfied were you with the solution that was provided to you today? Somewhat dissatisfied	How satisfied were you with the solution that was provided to you today? Very dissatisfied
How satisfied were you with the overall experience at Mobi today?	How satisfied were you with the overall experience at Mobi today? Very satisfied	How satisfied were you with the overall experience at Mobi today? Somewhat satisfied	How satisfied were you with the overall experience at Mobi today? Neither Satisfied nor dissatisfied	How satisfied were you with the overall experience at Mobi today? Somewhat dissatisfied	How satisfied were you with the overall experience at Mobi today? Very dissatisfied
How likely would you be to recommend this location to a friend?	How likely would you be to recommend this location to a friend? Very satisfied	How likely would you be to recommend this location to a friend? Somewhat satisfied	How likely would you be to recommend this location to a friend? Neither Satisfied nor dissatisfied	How likely would you be to recommend this location to a friend? Somewhat dissatisfied	How likely would you be to recommend this location to a friend? Very dissatisfied
How well did we meet your expectations for service and professionalism?	How well did we meet your expectations for service and professionalism? Very satisfied	How well did we meet your expectations for service and professionalism? Somewhat satisfied	How well did we meet your expectations for service and professionalism? Neither Satisfied nor dissatisfied	How well did we meet your expectations for service and professionalism? Somewhat dissatisfied	How well did we meet your expectations for service and professionalism? Very dissatisfied

7. Do you have any suggestions for improving our experience?

Do you have any suggestions for improving our experience?