1*:*id*:*type_section_break*:*type*:*custom_1*:*w_field_label*:*<h2>Sample Customer Satisfaction Survey</h2>*:*w_editor*:**:*new_field*:*2*:*id*:*type_own_select*:*type*:*Please rate the speed of service you received during this visit:*:*w_field_label*:*400*:*w_field_label_size*:*top*:*w_field_label_pos*:*200*:*w_size*:*Strongly Agree***Agree***Neither Agree nor Disagree***Disagree***Strongly Disagree*:*w_choices*:*true***false***false***false***false*:*w_choices_checked*:*false***false***false***false***false*:*w_choices_disabled*:*no*:*w_required*:*wdform_select*:*w_class*:**:*new_field*:*3*:*id*:*type_own_select*:*type*:*Overall, please rate the quality of service that you received during this visit*:*w_field_label*:*500*:*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*:*4*:*id*:*type_radio*:*type*:*Did you have any questions or concerns while you were visiting the Store?*:*w_field_label*:*500*:*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*:*5*:*id*:*type_radio*:*type*:*Were your questions or concerns addressed to your satisfaction while you were visiting the Store?*:*w_field_label*:*650*:*w_field_label_size*:*top*:*w_field_label_pos*:*hor*:*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*:*6*:*id*:*type_radio*:*type*:*Would you like a representative from the Store contact you regarding your concern?*:*w_field_label*:*600*:*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_phone*:*type*:*If in the question above you indicated that you would like to be contacted by a representative of the Store, please provide your preferred telephone number below.*:*w_field_label*:*700*:*w_field_label_size*:*top*:*w_field_label_pos*:*135*:*w_size*:*****:*w_first_val*:*****:*w_title*:*Area Code***Phone Number*:*w_mini_labels*:*no*:*w_required*:*no*:*w_unique*:**:*w_class*:**:*new_field*:*8*:*id*:*type_submit_reset*:*type*:*type_submit_reset_8*:*w_field_label*:*Submit*:*w_submit_title*:*Reset*:*w_reset_title*:**:*w_class*:*true*:*w_act*:**:*new_field*:*