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CUSTOMER SATISFACTION SURVEY

SURVEY KEPUASAN PELANGGAN
Name/ Nama :
Position/Jabatan :
Name of Hospital/ Nama Rumah Sakit :
or / atau
Name of Company/ Nama Perusahaan :

1. How long have you been a customer of our company?

Berapa lama andasudahmenjadipelanggan di perusahaan kami?
Less than six months / Kurangdarienam (6) bulan
6 months to a year / Enam (6) bulankesatu (1) tahun
1 -2 year / 1 -2 tahun
3 or more years / 3 tahunataulebih

2. Overall, how satisfied or dissatisfied are you with our company?

Secarakeseluruhan, seberapakepuasanatauketidakpuasanandaterhadapperusahaan kami?
Very Satisfied/ Sangatpuas
Somewhat satisfied / Puas
Neither satisfied nor dissatisfied/ Diantarapuasdantidakpuas
Somewhat dissatisfied/ TidakPuas
Very Dissatisfied/ Sangattidakpuas

3. Which of the following words would you use to describe our services? Select all that apply.
Apa kata yang tepat yang akan anda gunakan untuk mendeskripsikan layanan kami?
Pilihsemuajikamemungkinkan.
Excellent / Sangatbaik
High Quality/ Berkualitastinggi
Useful/ Bermanfaat
Ineffective/Tidakefektif
Poor Quality/ Berkualitasburuk

4. How well do our services meet your needs?

Seberapabaiklayanan kami memenuhikebutuhanAnda?
Extremely well/ Sangatbaik
Very well/ Baik
Somewhat well/ Cukupbaik
Not so well/ Tidakterlalubaik
Not at all well/Samasekalitidakbaik

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5. How would you rate the quality of our service?

Bagaimanaandamenilaikualitaslayanan kami?
Very high quality/ Berkualitas yang sangattinggi
High quality/ Berkualitastinggi
Neither high nor low quality/ Diantaraberkualitastinggidanrendah
Low quality / Berkualitasrendah
Very low quality/ Berkualitassangatrendah

6. How responsive are we in reacting and solving to your questions or concerns?

Seberaparesponsif kami dalammenjawabsetiappertanyaandanpermintaanAnda?
Extremely responsive / Sangatresponsif
Very responsive/ Responsif
Somewhat responsive/ Cukupresponsif
Not so responsive/ Tidakresponsif
Not at all responsive/ Sangattidakresponsif

7. How well do our officer meet your needs and provide the services?
Seberapa baik petugas kami memenuhi kebutuhan Anda dan memberikan layanan?
Excellent/ Sangatbaik
High Quality/ Berkualitastinggi
Useful/ Bermanfaat
Ineffective/ Tidakefektif
Poor Quality/ Berkualitasburuk

8. How likely are you to recommend our company to a friend or colleague?

Berapa besar kemungkinan Anda untuk merekomendasikan perusahaan kami untuk teman atau
kolega?

Not at all likely Extremely likely

Sama sekali tidak mungkin Sangat mungkin
0 1 2 3 4 5 6 7 8 9 10

9. Do you have any other comments, concerns or recommendation to help us serve you better?
Apakahandamemilikikomentarataurekomendasiuntukmembantu kami melayaniAndalebihbaik?

Signature with stamp / Tanda Tangan beserta stempel

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