Likelihood Survey Form
Please complete this survey to share your likelihood ratings, context, and any additional comments. Use the same title consistently throughout the form.
Respondent Profile
Respondent Name
First Name
Last Name
Email for Follow-up
example@example.com
Organization / Company
Likelihood Survey Questions
Likelihood to take action, recommend, continue, purchase/try/use, and revisit/follow up
*
Rows
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
Take action based on this experience
1
2
3
4
5
Recommend to others
6
7
8
9
10
Continue using or engaging
11
12
13
14
15
Purchase, try, or use again
16
17
18
19
20
Revisit or follow up in the future
21
22
23
24
25
Overall likelihood
*
Very Unlikely
1
2
3
4
Very Likely
5
1 is Very Unlikely, 5 is Very Likely
Primary intent or expected action
*
Take action now
Recommend to others
Continue using or engaging
Purchase, try, or use again
Revisit or follow up later
No action planned
Other
Any additional likelihood-related comments
Context and Follow-up
Additional comments or reasons behind your ratings
Preferred follow-up contact method
Please Select
Email
Phone
Text message
No follow-up needed
Permission to contact me for clarification
Yes, you may contact me
No, please do not contact me
Submit
Should be Empty: