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CUSTOMER FEEDBACK FORM
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Completion Meter
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Step
1
of 5
Customer Satisfaction Rating
*
Rate 1 out of 5
Rate 2 out of 5
Rate 3 out of 5
Rate 4 out of 5
Rate 5 out of 5
Name
*
First
Last
Phone
Email
Are you a Prepaid LegalShield Member?
*
Yes
No
I don't know
Intake Number
What is your preferred contact method
*
Select Contact Method
Phone
E-Mail
Text Message
I do not wish to be contacted at this time.
We'll use this to get in touch with you, so we can make things right and deserve 5 STARS next time
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How likely are you to recommend us to a friend or colleague?
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Not at all Likely
Extremely Likely
0
1
2
3
4
5
6
7
8
9
10
How did we disappoint you and what can we do to make things right?
*
What could we do to improve?
*
Would you like to add any additional comments about this experience?
Would you be willing to provide us a testimonial?
*
Yes
No
Next
How likely are you to recommend us to a friend or colleague?
*
Not at all Likely
Extremely Likely
0
1
2
3
4
5
6
7
8
9
10
What did you like best about this experience?
Is there anything else you think could approve this experience?
Would you like to add any additional comments about this experience?
Would you be willing to provide us with a 5-Star Google Review?
*
Yes
No
Next
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