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What is the purpose of the item in question?
Assist you whilst bathing? Assist you using the toilet? Assist you around the home? Assist your access to your home?
 
 

Are you able to grip well?
Yes No Sometimes
 
 

What kind of surface would you like the rail to have?
Smooth Textured Ribbed No preference
 
 

Would you prefer another colour than white, if so what?
Yes No State colour
 
 
 
Overall, how would you rate our service so far?
Excellent Good Average Poor Terrible
 
 

Would you use our service in the furture?
Definately Yes No Maybe
 
 
 
How satisfied are you with your service from [COMPANY]?
 
Extremely satisfied
 
Very satisfied
 
Neutral
 
Very dissatisfied
 
Extremely dissatisfied
 
 
 
How important is the positioning of your rail?
Extremely Fairly Not important
 
 

If you had a choice where you put the rail at the entrance, where would you prefer it?
On the outside wall On the inside reveal
 
 
 
Have you got any suggestions that may assist us in this evaluation?
   
 
 
 
For your NEXT [PRODUCT] purchase, how likely are you to purchase from [COMPANY]?
 
Very likely
 
Somewhat likely
 
Not sure
 
Somewhat unlikely
 
Very unlikely
 
 
 
Which of the following modes did you use to place the LAST order for [PRODUCT]?
 
Mail order
 
Internet
 
Over the phone
 
Fax
 
Other
 
 
 
 
What are the THREE main reasons you didn't purchase [PRODUCT] from [COMPANY]?
   
 
 
 
If you could change something about [COMPANY] what would it be?
   
 
 
 
Are there any other comments you have for [COMPANY]?
   
 
Please contact [email protected] if you have any questions regarding this survey.
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