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Evaluation
Form
First name
Last name
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How long have you used our product or service?
Less than a month
1-3 months
3-6 months
6 months to 1 year
More than 1 year
Please rate your product/service satisfaction level:
Rows
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Overall satisfaction
1
2
3
4
5
Purchase experience
6
7
8
9
10
Price
11
12
13
14
15
Delivery
16
17
18
19
20
Operating instructions
21
22
23
24
25
Installation or first use experience
26
27
28
29
30
Post-purchase experience
31
32
33
34
35
Customer service
36
37
38
39
40
Technical support
41
42
43
44
45
Quality
46
47
48
49
50
Suggestions for improvement
Additional comments
Submit
Should be Empty: