Customer Satisfaction Survey Template Question Title * 1. How likely is it that you would recommend organisation 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 organisation? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied OK Question Title * 3. How responsive have we been to your questions or concerns about our services? Extremely responsive Very responsive Somewhat responsive Not so responsive Not at all responsive Not applicable OK Question Title * 4. How likely are you to purchase any of our services again? Extremely likely Very likely Somewhat likely Not so likely Not at all likely OK Question Title * 5. Do you have any other comments, questions, or concerns? OK Question Title * 6. What services did you receive? Occupational Therapy Physiotherapy Speech Pathology Dietetics Exercise Physiology At home services Services in our clinics OK Question Title * 7. How were your services funded? NDIS DVA Other Insurance Private Home Care Package (aged care) Medicare OK Question Title * 8. If you would like to be contacted please provide your details below: Name Company City/Town State/Province Email Address Phone Number OK DONE