Feedback Form Questions
The feedback form is used to bring to attention information that can be used to improve an organization’s services and products. The format used should give a quick and easy overview for the customer. The questions should also be more specific rather than general.
Thank you for taking time to give us your feedback. Your feedback is important in helping us improve our products and services.
1) What kind of feedback would you like to provide
? Suggestion
?Complaint
?Ask for information
?Make an order
?Other (Specify) ___________________________________
2) How would you like us to contact you?
? No contact
? Email ________________________
?Phone ________________________
?Fax __________________________
3) Check the appropriate boxes
What is your age bracket?
?15-25 ? 26-35 ? 36-45 ? 46-55 ? Over 55
What is your ethnicity?
? White ? Black ? Mixed ? other ? Prefer not to say
Gender: ? Male ? Female
4) How did you like our services/products?
1 ? 2 ? 3 ? 4 ? 5 ?
5) Were your needs appropriately met?
1 ? 2 ? 3 ? 4 ? 5 ?
6) How did you know about us? ____________________________
7) Would you recommend our products/services to another person? ______
Were you able to easily find what you were looking for?
? Yes ? No
9) Please rate the quality of our products
1 ? 2 ? 3 ? 4 ? 5 ?
9) Please rate the quality of our services
1 ? 2 ? 3 ? 4 ? 5 ?
10) In which area do you think we need to improve? ____________________
………………………………………….
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