1*:*id*:*type_section_break*:*type*:*custom_1*:*w_field_label*:*<h2 style="color: rgb(153, 153, 153);">Sample Customer Survey</h2>*:*w_editor*:**:*new_field*:*2*:*id*:*type_section_break*:*type*:*custom_2*:*w_field_label*:*<p><span style="color: rgb(153, 153, 153); font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 18px; line-height: normal;">Understanding why recent customers do not plan to return to a particular store, this survey addresses reasons for dissatisfaction and requests suggestions on how the store can improve.</span></p>*:*w_editor*:**:*new_field*:*3*:*id*:*type_radio*:*type*:*Do you ever plan to return to this store?*:*w_field_label*:*300*:*w_field_label_size*:*top*:*w_field_label_pos*:*ver*:*w_flow*:*Yes***No*:*w_choices*:*false***false*:*w_choices_checked*:*1*:*w_rowcol*:*no*:*w_required*:*no*:*w_randomize*:*no*:*w_allow_other*:*0*:*w_allow_other_num*:**:*w_class*:**:*new_field*:*4*:*id*:*type_own_select*:*type*:*Overall, please rate the quality of customer service that you received during this visit.*:*w_field_label*:*550*:*w_field_label_size*:*top*:*w_field_label_pos*:*200*:*w_size*:*-Select-***Very Good***Good***Neutral***Poor***Very Poor*:*w_choices*:*true***false***false***false***false***false*:*w_choices_checked*:*false***false***false***false***false***false*:*w_choices_disabled*:*no*:*w_required*:*wdform_select*:*w_class*:**:*new_field*:*5*:*id*:*type_checkbox*:*type*:*What were the main reasons for the poor quality of customer service? Please select all that apply.*:*w_field_label*:*600*:*w_field_label_size*:*top*:*w_field_label_pos*:*ver*:*w_flow*:*Not attentive enough***Too pushy***Not knowledgeable enough***Rude***Disrespectful***Did not listen to my needs***Too slow***Other*:*w_choices*:*false***false***false***false***false***false***false***false*:*w_choices_checked*:*1*:*w_rowcol*:*no*:*w_required*:*no*:*w_randomize*:*yes*:*w_allow_other*:*7*:*w_allow_other_num*:**:*w_class*:**:*new_field*:*6*:*id*:*type_radio*:*type*:*Did you file a formal complaint regarding the customer service?*:*w_field_label*:*400*:*w_field_label_size*:*top*:*w_field_label_pos*:*ver*:*w_flow*:*Yes***No*:*w_choices*:*false***false*:*w_choices_checked*:*1*:*w_rowcol*:*no*:*w_required*:*no*:*w_randomize*:*no*:*w_allow_other*:*0*:*w_allow_other_num*:**:*w_class*:**:*new_field*:*7*:*id*:*type_radio*:*type*:*When was this complaint filed?*:*w_field_label*:*250*:*w_field_label_size*:*top*:*w_field_label_pos*:*ver*:*w_flow*:*During the visit to the store***After the visit to the store*:*w_choices*:*false***false*:*w_choices_checked*:*1*:*w_rowcol*:*no*:*w_required*:*no*:*w_randomize*:*no*:*w_allow_other*:*0*:*w_allow_other_num*:**:*w_class*:**:*new_field*:*8*:*id*:*type_radio*:*type*:*Did anyone from the store follow-up with you about the complaint?*:*w_field_label*:*400*:*w_field_label_size*:*top*:*w_field_label_pos*:*ver*:*w_flow*:*Yes***No*:*w_choices*:*false***false*:*w_choices_checked*:*1*:*w_rowcol*:*no*:*w_required*:*no*:*w_randomize*:*no*:*w_allow_other*:*0*:*w_allow_other_num*:**:*w_class*:**:*new_field*:*9*:*id*:*type_radio*:*type*:*Would you like a store representative to contact you?*:*w_field_label*:*350*:*w_field_label_size*:*top*:*w_field_label_pos*:*ver*:*w_flow*:*Yes***No*:*w_choices*:*false***false*:*w_choices_checked*:*1*:*w_rowcol*:*no*:*w_required*:*no*:*w_randomize*:*no*:*w_allow_other*:*0*:*w_allow_other_num*:**:*w_class*:**:*new_field*:*10*:*id*:*type_radio*:*type*:*Were you satisfied with the follow-up to your complaint?*:*w_field_label*:*350*:*w_field_label_size*:*top*:*w_field_label_pos*:*ver*:*w_flow*:*Yes***No*:*w_choices*:*false***false*:*w_choices_checked*:*1*:*w_rowcol*:*no*:*w_required*:*no*:*w_randomize*:*no*:*w_allow_other*:*0*:*w_allow_other_num*:**:*w_class*:**:*new_field*:*11*:*id*:*type_textarea*:*type*:*Why werent you satisfied with the follow-up to your complaint?*:*w_field_label*:*400*:*w_field_label_size*:*top*:*w_field_label_pos*:*400*:*w_size_w*:*100*:*w_size_h*:**:*w_first_val*:**:*w_title*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:**:*new_field*:*12*:*id*:*type_radio*:*type*:*What is the highest level of education that you have achieved?*:*w_field_label*:*400*:*w_field_label_size*:*top*:*w_field_label_pos*:*ver*:*w_flow*:*Less than high school degree***High school degree or GED***Associates degree or trade school***College degree***Graduate school degree*:*w_choices*:*false***false***false***false***false*:*w_choices_checked*:*1*:*w_rowcol*:*no*:*w_required*:*no*:*w_randomize*:*no*:*w_allow_other*:*0*:*w_allow_other_num*:**:*w_class*:**:*new_field*:*13*:*id*:*type_radio*:*type*:*What was your household income last year?*:*w_field_label*:*400*:*w_field_label_size*:*top*:*w_field_label_pos*:*ver*:*w_flow*:*$0 to $24,999***$25,000 to $49,999***$50,000 to $74,999***$75,000 to $99,999***$100,000 to $124,999***$125,000 to $149,999***$150,000 or more*:*w_choices*:*false***false***false***false***false***false***false*:*w_choices_checked*:*1*:*w_rowcol*:*no*:*w_required*:*no*:*w_randomize*:*no*:*w_allow_other*:*0*:*w_allow_other_num*:**:*w_class*:**:*new_field*:*14*:*id*:*type_submit_reset*:*type*:*type_submit_reset_14*:*w_field_label*:*Submit*:*w_submit_title*:*Reset*:*w_reset_title*:**:*w_class*:*true*:*w_act*:**:*new_field*:*