* 1. Overall, how satisfied or dissatisfied are you with our services?

* 2. Which of the following words would you use to describe our services? Select all that apply.

* 3. How well do our services meet your needs?

* 4. How would you rate the quality and value of our services?

* 5. How responsive have we been to your questions or concerns about services?

* 6. How long have you been a customer of our agency?

* 7. How likely are you to use our services again?

* 8. How likely is it that you would recommend agency to a friend or colleague?

Not at all likely
Extremely likely

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

* 10. Your contact information.