Contact Us: Customer Satisfaction Survey
Customer Satisfaction Survey

How are we doing?

Will you take five minutes to reply to our 3 satisfaction survey questions?

 

* Indicates a required field

 

Facility Name:

*
 

Department:

*

 

Job Title:

 
 

First Name:

*
 

Last Name:

*
 

Telephone:

*

Ext:

 

Your Email:

*

* How would you rate STAXI’s product quality out of 5?

Very Dissatisfied 1. 2. 3. 4. 5. Very Satisfied

* How would you rate STAXI’s service quality out of 5?

Very Dissatisfied 1. 2. 3. 4. 5. Very Satisfied

* Would you recommend STAXI to colleagues at other facilities?

1. Yes

2. No

1. Referral

Facility Name:

Address:

City:

Zip/Postal Code:

Country:

First Name:

Last Name:

Title:

Department:

Telephone:

Email:

2. Referral

Facility Name:

Address:

City:

Zip/Postal Code:

Country:

First Name:

Last Name :

Title:

Department:

Email:

Telephone:

3. Referral

Facility Name:

Address:

City:

Zip/Postal Code:

Country:

First Name:

Last Name :

Title:

Department:

Email:

Telephone:

 

Thank you for your time! Thank you for choosing STAXI!