Prepared by:

[Your Name]

Company Name:

[Your Company Name]

Date:

[Date]

Demographic Information:

Age:

• Under 18 years

• 18-24 years

• 25-34 years

• 35-44 years

• 45-54 years

• 55-64 years

• 65 years or older

Employment Status:

• Employed full-time

• Employed part-time

• Self-employed

• Unemployed

• Student

• Retired

• Other (please specify)

Gender:

• Male

• Female

• Non-binary/Third gender

• Prefer not to say

A. General Product Experience

1. How long have you been using our product?

• Less than a month

• 1-6 months

• 6-12 months

• More than 1 year

2. How often do you use our product?

• Daily

• Weekly

• Monthly

• Less often

3. How would you rate the overall quality of our product?

• 1 - Poor

• 2 - Below Average

• 3 - Average

• 4 - Above Average

• 5 - Excellent

B. Product Usability

4. How easy or difficult did you find the initial setup of the product?

• 1 - Very Easy

• 2 - Easy

• 3 - Neutral

• 4 - Difficult

• 5 - Very Difficult

5. How sufficient are the product features for your needs?

• 1 - Not at all sufficient

• 2 - Not so sufficient

• 3 - Somewhat sufficient

• 4 - Very sufficient

• 5 - Extremely sufficient

C. Customer Support

6. Have you had to contact our customer support with an issue/question about the product?

• Yes

• No

If yes, please continue. If no, proceed to the next section

7. How would you rate the response speed of our customer support?

• Very Slow

• Slow

• Average

• Fast

• Very Fast

8. How helpful was our customer support in solving your problem/question?

• Not at all helpful

• Not so helpful

• Somewhat helpful

• Very helpful

• Extremely helpful

D. Product Improvement

9. What do you like the LEAST about our product?

10. What improvements would you suggest for our product?