Health Product Satisfaction Survey
Survey Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Health Product Name
Type of Health Product
Pharmaceutical products
Supplements
Organic Remedies
Medical devices
Health and Beauty
Sports and Fitness
Other
Health Product Description (General purpose)
How long have you been using this health product?
Months, weeks, or days
Are you familiar with the company who created this health product?
Yes
No
Have you purchased any other products from this company? If yes, are you satisfied with it?
Does this product have warranty?
Yes
No
How much is this health product ($)?
How often do you use this product?
Monthly
Weekly
Daily
Rarely
Never
How would you rate this product?
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Product Quality
1
2
3
Product Design
4
5
6
Effectiveness
7
8
9
Easy to use?
10
11
12
Purchase Experience
13
14
15
Price (SRP)
16
17
18
Result Outcome
19
20
21
Instructions
22
23
24
Documentation
25
26
27
After purchase support
28
29
30
Customer Service
31
32
33
Are you going to recommend this to your friends, family or colleagues?
Definitely
Probably
Not sure
Definitely not
Are you going to buy this product again?
Yes
No
Maybe
Feedback about the product
Participant's Name
First Name
Last Name
Gender
Male
Female
Age Group
0-14 years old
15-24 years old
25-64 years old
65 years old and above
Participant's Phone Number
Format: (000) 000-0000.
Participant's Email
example@example.com
Would it be okay if we contact you so that you can further explain your feedback about our product?
Yes
No
Would you like to receive updates and promotional emails from us?
Yes
No
Submit
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