Customer Satisfaction Survey Template

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* 1. Your Name - Please note you can remain anonymous and leave this blank

Name

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* 2. How likely are you to recommend Gratis Home Care to a friend or family member?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

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* 3. What services do you receive from Gratis Home Care

Domestic Support (Cleaning)

Personal Care

Gardening

Maintenance

Social Support

Transport

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* 4. Overall, how satisfied or dissatisfied are you with Gratis Home Care?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

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

Reliable

High quality

Useful

Unique

Good value for money

Overpriced

Impractical

Ineffective

Poor quality

Unreliable

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

Extremely well

Very well

Somewhat well

Not so well

Not at all well

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* 7. How would you rate the quality of the service?

Very high quality

High quality

Neither high nor low quality

Low quality

Very low quality

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* 8. How would you rate the value for money of the service?

Excellent

Above average

Average

Below average

Poor

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* 9. 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

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* 10. How long have you been a customer of Gratis Home Care?

I've just signed up

Less than six months

Six months to a year

1 - 2 years

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* 11. Are you unhappy with a particular service?

Domestic Services (Cleaning)

Personal Care Services

Gardening Services

Maintenance Services

Social Support

Transport

Can you please let us know how we can improve on this?

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

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* 13. If you would like us to contact you with regards to this survey, please leave your details here and we will be in touch.

Name

Email Address

Phone Number