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Customer Satisfaction Form PDF

This document contains a customer satisfaction survey form for Poly Medicure Limited. The 3-page form asks customers to rate their satisfaction on various topics related to product quality, sales, service, and the overall performance of the company on a scale of 1 to 5. It collects information about the customer and their representative. At the end, it asks if the customer would recommend Poly Medicure to others and includes a section for comments and suggestions.

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Pankaj Kumar
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1K views2 pages

Customer Satisfaction Form PDF

This document contains a customer satisfaction survey form for Poly Medicure Limited. The 3-page form asks customers to rate their satisfaction on various topics related to product quality, sales, service, and the overall performance of the company on a scale of 1 to 5. It collects information about the customer and their representative. At the end, it asks if the customer would recommend Poly Medicure to others and includes a section for comments and suggestions.

Uploaded by

Pankaj Kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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POLY MEDICURE LIMITED Document No.

: F/MKT/18
Revision No. : 00
CUSTOMER SATISFACTION SURVEY FORM

EVALUATION BY CUSTOMER FOR THE PERIOD: _

Date: Region:

Dear Valued Customer,


You are a highly respected customer for our company.
As per our commitment to customer satisfaction, ISO 9001:2008 and ISO 13485:2003 Conformance, we
intended to use your feedback to improve our management systems and our services to you. Please spare
few minutes to complete the form below.

Detail of Customer Detail of Customer’s Representative

Name of customer : Name :


Address : Designation :
Phone/ Fax No. :
Mobile No. :
E -Mail :

Rate on the scale of 1 to 5 as given below-


Evaluation Totally Somewhat Neutral Somewhat Totally
Quality Rating
Topic Satisfied Satisfied Unsatisfied Unsatisfied
(5) (4) (3) (2) (1)
Quality

Performance

Availability
Product
On Time Delivery

Value/Price
Quality of
Packaging
Response to Sales
Query
Problem Solving
Sales
Knowledge of
Product
Employee
Mannerism
Telephone
Assistance
Response Time
Service
Complaint
Resolving Ability
Quality of Technical
Training

Document Reference No.: QP/MKT/02


POLY MEDICURE LIMITED Document No.: F/MKT/18
Revision No. : 00
CUSTOMER SATISFACTION SURVEY FORM

Rate on the scale of 1 to 5 as given below-


Evaluation Totally Somewhat Neutral Somewhat Totally
Quality Rating
Topic Satisfied Satisfied Unsatisfied Unsatisfied
(5) (4) (3) (2) (1)
Performance of our
Overall
Company

Based on your experience, would you recommend POLYMED to others

Yes : No : Can’t Say :

Comments / Suggestions (if any)

Name of Customers Representative :

Sign of Customers Representative :

Date & Stamp :

Document Reference No.: QP/MKT/02

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