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Customer Satisfaction Survey Template

1.Overall, how satisfied or dissatisfied are you with Michelle Kane?
2.Overall, on a scale of 0-10 (0 being the lowest and 10 being most satisfied) how satisfied have you been with Michelle's services?
Very Dissatisfied
0
1
2
3
4
Neither Satisfied nor Dissatisfied
5
6
7
8
9
Very Satisfied
10
3.What does Michelle do really well?
4.What clinical areas or skilled practice do you perceive Michelle to specialize in?
5.What changes would Michelle have to make for you to give it a higher rating?
6.Which of the following words would you use to describe our services? Select all that apply.
7.How well do our services meet your needs?
8.How would you rate the quality of our services?
9.How responsive have we been to your questions or concerns about our services?
10.How long have you been a customer of Michelle’s?
11.What is your typical frequency of visits or use of services?
12.What type of services have you used? Select all that apply.
13.How likely are you to use our service again in the future?
14.
On a scale of 0 to 10,
How likely is it that you would recommend Michelle to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likelyExtremely likely
15.What prompted you to seek services at the time that you did?
16.What factors prompted you to select Michelle as your service provider?
17.Would you like to provide an anonymous written testimonial? If so, please do so below in as great detail as you wish. Some questions to think through:
  • What has been your experience so far of Michelle, and what she does really well.
  • What have you learned or deepened in your work together?
  • How would you explain what is unique about Michelle with regards to other providers and services?
18.What is your gender?
19.What is your age?
20.Do you have any other comments, questions, or concerns?
21.What is the nature of your working relationship with Michelle?