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Customer Satisfaction Survey Template 2021
1.
When did you last receive a product or service (e.g. loan or counseling session) from Justine PETERSEN?
0-3 months ago
4-6 months ago
7-9 months ago
10-12 months ago
12+ months ago
2.
When did you first start working with Justine PETERSEN?
In the last 12 months
Between 1-2 years ago
Between 3-5 years ago
Between 5-10 years ago
More than 10 years ago
3.
If you interacted with Justine PETERSEN staff, how flexible would you say staff were?
Very flexible
Somewhat flexible
Neutral
Somewhat inflexible
Very inflexible
4.
If you interacted with Justine PETERSEN staff, how respectful would you say staff were?
Very respectful
Somewhat respectful
Neutral
Somewhat disrespectful
Very disrespectful
5.
Please describe your experience with the JP staff person ( or persons) who you interacted with.
6.
Which Justine PETERSEN products or services have you used? Please check all that apply.
Credit Building Counseling
Personal Loan
Credit Building/Save2Build Loan
Small Business Loan
Homebuyer Education and Counseling
Foreclosure Intervention
Other (please specify)
7.
If you received more than one service from JP. which service felt most useful to you and why?
8.
Are there any positive changes/improvement after you received services from JP?
Yes
No
9.
On a scale of 0 to 10,
How likely is it that you would recommend this company to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
10.
Has your quality of life changed because of Justine PETERSEN's products or services?
Very Much Improved
Slightly Improved
No Change
Got Slightly Worse
Got Much Worse
Please explain your answer.
11.
Have you experienced any challenges with accessing or using Justine PETERSEN's products or services? If so, what were they?
12.
Is there anything Justine PETERSEN could offer that would better meet your needs?
13.
Do you have access to a computer with audio/video capabilities?
Yes
No
14.
Would you be interested in and comfortable with video services through a platform such as Zoom or FaceTime given the option?
Yes
No
15.
What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
16.
Please identify your race.
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Another race
17.
Please identify your ethnicity.
Hispanic Origin
Not Hispanic Origin
18.
Please identify your gender.
Male
Female
Other (please specify)
19.
What is your zip code?
20.
Please estimate your annual income:
$0-$15,000
$15,001-$40,000
$40,001+
Current Progress,
0 of 20 answered