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Asking Questions - The Definitive Guide To Questionnaire Design ...

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426 APPENDIX D<br />

You are a valued customer. What you have to say is important to us. Please take<br />

a moment to let us know how we are doing by filling out this card, by calling<br />

Customer Service at 1–800-xxx-xxxx, or by visiting our Web site.<br />

Overall, how satisfied were you with your experience with us today?<br />

(Circle one)<br />

Extremely<br />

Dissatisfied<br />

Extremely<br />

Satisfied<br />

What do we do well?<br />

1 2 3 4 5 6 7 8 9<br />

What should we change?<br />

What can we do to serve you better?<br />

Additional comments?<br />

Date of visit:<br />

Time of day:<br />

Name:<br />

Address:<br />

City/State/Zip:<br />

Area Code:<br />

Telephone:<br />

Occupation:<br />

Thanks for your patronage.

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