[INSERT SURVEY TITLE]

 

 

 

 

 

Prepared By: [SPECIFY THE NAME]

 

 

 

Name (Optional):
Age:
Gender:
Address:
Contact Number:

 

 

 

 

 

Date of Survey:  00.00.20 [            ]

 

 

 

1. 1. I discovered [SPECIFY THE NAME OF THE PRODUCT] through [ ].

 

 

 

2. 2. I use the product at least [ ] times in a month.

 

 

 

3. 3. I am [ ] with the product. (State if satisfactory or not)

 

 

 

4. 4. The product is [ ] in my daily activities. (State if helpful or not)

 

 

 

5. 5. My purpose of using the product is [ ].

 

 

 

6. 6. The product is [ ]. (State if effective or not)

 

 

 

7. 7. I am likely to [ ] this product. (State if you will buy the product or not)

 

 

 

8. 8. If given the chance, I would like to change the [ ]. (State the kind of change you want with the product)

 

 

 

 

 

Thank you for answering this survey!