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Revelation Health Customer Survey & Satisfaction Form
Step 1 of 3
Your Latest Order Number
This number is available on your invoice or receipt.
Date of Purchase
*
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Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
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22
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31
Year
2023
2024
2025
This order was placed:
*
Online
Over the phone
In-Store
Email
*
Online Order Satisfaction
Step 2 of 3
How often do you visit RevelationHealth.com?
*
This was my first visit
Daily
Weekly
Bi-Weekly
Monthly
Annually
How helpful was our support team (If you used our online chat feature)
*
Very Helpful
Helpful
Somewhat Helful
Not Very Helpful
Very Unhelpful
I Did Not Use the Online Help Feature
Was our website user-friendly?
*
Very User-Friendly
User-Friendly
Somewhat User-Friendly
Not Very User Friendly
Not User-Friendly at All
What product(s) did you order? (You may use category)
*
How did you learn about RevelationHealth.com?
*
Select One
DrPompa.com
Google
Yahoo
Bing
Advertisement
Other
Please List Other:
*
What do we do really well at RevelationHealth.com?
*
What can we do better at RevelationHealth.com
*
Telephone Order Satisfaction
Step 2 of 3
How would you rate your experience with Revelation Health?
*
1
2
3
4
5
6
7
8
9
10
1= horrible experience • 5= Average Experience • 10= Amazing Experience
How often do you call Revelation Health?
*
This was my first call
Daily
Weekly
Bi-Weekly
Monthly
Annually
Have your calls been handled professionally and promptly?
*
Yes
No
Other
Please Explain:
*
Please tell us about your experience:
*
In-Store Satisfaction
Step 2 of 3
What made you visit our store?
*
What team member did you work with?
*
How helpful was our team?
*
Very Helpful
Helpful
Somewhat Helful
Not Very Helpful
Very Unhelpful
I Did Not Use the Online Help Feature
How often do you visit Revelation Health?
*
This was my first visit
Daily
Weekly
Bi-Weekly
Monthly
Annually
Please tell us about your experience:
*
You're almost there!
Step 3 of 3
How likely is it that you would recommend Revelation Health to a friend or colleague?
*
0
1
2
3
4
5
6
7
8
9
10
0= Not Likely at All • 5= Neutral • 10= Extremely Likely
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