Quality Senior Care Support LLC - Customer Satisfaction Survey Question Title * 1. How likely is it that you would recommend QSCS 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 QSCS? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied OK Question Title * 3. How well do our services meet your needs? Extremely helpful Very helpful Somewhat helpful Not so helpful Not at all helpful OK Question Title * 4. How would you rate the quality of the information? Extremely helpful Very helpful Somewhat helpful Not so helpful Not at all helpful OK Question Title * 5. How responsive have we been to your questions or concerns about insurance issues? Extremely responsive Very responsive Somewhat responsive Not so responsive Not at all responsive OK Question Title * 6. How long have you been a customer of QSCS? This is my first purchase Less than six months Six months to a year 1 - 2 years 3 or more years I haven't made a purchase yet OK Question Title * 7. How likely are you to purchase any of our Monthly Service again? 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? OK Question Title * 9. Please complete the information below to receive information from QSCS. Name Company Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number OK NEXT