Customer Satisfaction Survey Template Question Title * 1. How likely is it that you would recommend Whole Family to a friend or colleague? NOT AT ALL LIKELY EXTREMELY LIKELY 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 OK Question Title * 2. Overall, how satisfied or dissatisfied are you with Whole Family? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied OK Question Title * 3. How would you rate the quality of care? Very high quality High quality Neither high nor low quality Low quality Very low quality OK Question Title * 4. How would you rate the value for money of our DPC model? Excellent Above average Average Below average Poor OK Question Title * 5. How responsive have we been when you need an appointment? Extremely responsive Very responsive Somewhat responsive Not so responsive Not at all responsive Not applicable OK Question Title * 6. How long have you been a patient of Whole Family? Just joined Less than six months Six months to a year 1 - 2 years 3 or more years I haven't become a member yet OK Question Title * 7. How likely are you to try any of our other services? (acupuncture, massage, yoga, weight loss group) Extremely likely Very likely Somewhat likely Not so likely Not at all likely OK Question Title * 8. Do you have any other comments, questions, or concerns? (What else would you like us to offer?) OK DONE