Referral Exchange Review Form
Please provide your feedback on your recent referral exchange to help us improve our process.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Organization or Company Name
Name of the Person/Organization You Are Reviewing
*
Date of Referral Exchange
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Referral Exchanged
*
Please Select
Business Lead
Client Introduction
Service Recommendation
Job Opportunity
Other
Please rate the overall quality of the referral you received/gave.
*
1
2
3
4
5
How would you rate the following aspects of the referral exchange?
*
Rows
Timeliness
Professionalism
Communication
Relevance of Referral
Excellent
1
2
3
4
Good
5
6
7
8
Average
9
10
11
12
Poor
13
14
15
16
How likely are you to participate in another referral exchange with this person/organization?
*
Not Likely
1
2
3
4
5
6
7
8
9
Very Likely
10
1 is Not Likely, 10 is Very Likely
What did you appreciate most about this referral exchange?
What could be improved in future referral exchanges?
Would you recommend this referral exchange program to others?
*
Yes
No
Maybe
Additional Comments (optional)
Submit Review
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