Customer Satisfaction & Impact Survey
Please feel free to print and mail this survey back to us or drop it off in the lobby in our survey box. Please do not put your name on this survey, or on the return label on your envelop if you are mailing this survey, unless you want us to talk to you personally about your feedback. Thank you so much for helping us to grow and to become even better! Please feel free to write on additional paper also if needed.
1. How long have you used our products/service? ____3 month or less _____3-6months _____6-12 months ____ 1-3years _____3-5years _____6-10years ______10+years
2. Why did you become a member?
3. Do you have any previous martial art experiences? ____Yes ____No
4. What is the most important aspect or thing/s you would like to gain from utilizing our services?
5. Which of our services do you use? _______Martial Arts, Fitness, Wellness Program, or Life Coaching for Self ________ Martial Arts, Fitness, Wellness Program, or Life Coaching for a Family Member
6. How would you rate your overall satisfaction with us on a scale of 1 to 10? __________
7. Are you aware of our status as a Benefit Corporation and B Corp Certification? ____Yes _____No
8. If answered yes, did our status as a Benefit Corporation or B Corp Certification have any influence on your desire to check us out or sign up for our services? ____Yes ____Not at all ____Somewhat
9. How important is it to you that the goods and services you purchase have a positive impact on their community and/or environment? ___Very Important ____Somewhat Important ____Not Important
10. How would you rate our overall staff in helpfulness from 1-10 _________
11. Please feel free to give us feedback on any of our staff:
12. Is there anything else you would like to share with us that is not addressed on this survey?
13. Please indicate your gender: ____M ____F
14. What Is Your Ethnicity?
_____African American _____Asian _____Hispanic _____Pacific Islander _____White
15. Are you of Hispanic, Latino, or Spanish origin? ______No _____Yes
16. Which range includes your age? _____Younger than 18 _____18-24 ______25-34 _____35-44 _____55-64 _____65 or older
17. Approximately how far do you live from us? ____Within 3 miles ____3-6 miles ____6 -10 miles _____10-15 miles ____more than 15 miles. If more than 15 miles, approximately how many _________
18. What was your total household income before taxes during the past 12 months? _______Less than $25,000 _______$25,000 to $34,999 _______$35,000 to $49,999 _______$50,000 to $74,999 _______$75,000 to $99,999 _______$100,000 to $149,999 _______$150,000 or more
19. What is the highest degree or level of education you have completed? ____Less than high school ____High school graduate (includes equivalency) ____Some college, no degree ____Associate's degree ____Bachelor's degree ____Master’s Degree or Professional Degree ____Ph.D.
20. What is your marital status? ______Single (never married) ______Married ______Separated ______Widowed ______Divorced
Thank you so much for your time and your feedback! We appreciate the opportunity to serve you and to learn from you!