Copy of Customer Satisfaction Survey Template Sleep Study questionnaire Question Title * 1. How likely is it that you would recommend Sleep Center to a friend or colleague? NOT AT ALL LIKELY EXTREMELY LIKELY 0 1 2 3 4 5 6 7 8 9 10 Not at all likely - 0 1 2 3 4 5 6 7 8 9 Extremely likely - 10 OK Question Title * 2. Overall, how satisfied or dissatisfied are you with Center? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied OK Question Title * 3. Which of the following words would you use to describe sleep Study? Select all that apply. Reliable High quality Useful Ineffective OK Question Title * 4. How clean was the facility Extremely well Very well Somewhat well Not so well Not at all well OK Question Title * 5. How would you rate the Patient Coodinator Excellent Very good Good Fair Very low quality Low none OK Question Title * 6. How would you rate Bed comfort Excellent Above average Average Below average Poor OK Question Title * 7. How responsive have we been to your questions or concerns about comments? Extremely responsive Very responsive Somewhat responsive Not so responsive Not at all responsive Not applicable OK Question Title * 8. How was night Technician Professional and courteous, excellent Average Not helpful OK Question Title * 9. How likely are you going to refer anyone to our facility Extremely likely Very likely Somewhat likely Not so likely Not at all likely OK Question Title * 10. Do you have any other comments, questions, or concerns? OK DONE