Client Preferences |

Date
Date Format: MM slash DD slash YYYY
Ref ID
Name*
First Last
Primary Email*
Customer Experience
We would like to know how we are doing so far. Please let us know how your last transaction was handled by our team.
Who handled your latest transaction with our office?*
- Elaine
- Jeff
- Kim
- Megan
- Rudy
- Can't Remember
How was your service/quote handled?*
- Over the Phone
- Through Email
- Both Phone and Email
- In Office
- Video or Web Meeting
FRIENDLINESS:*
Unacceptable Could have been better Good Very Good Exceptional
PROFESSIONALISM:*
Unacceptable Could have been better Good Very Good Exceptional
KNOWLEDGE OF PRODUCTS:*
Unacceptable Could have been better Good Very Good Exceptional
EXPLANATION OF CHOICES:*
Unacceptable Could have been better Good Very Good Exceptional
What could we have done to improve?
We love true and honest feedback. Feel free to suggest ideas on how we can improve. If you would like to recognize one of our team members for AWESOME service, we love to hear that to!
Preferences
Your preferred communication preference:*
There are many ways you can communicate with our office. From the list below, please identify your PREFERRED method of communication. You are free to select more than one if applicable.
- Call Cell
- Call Office
- DO NOT CALL
- Call Home
- Text
- DO NOT TEXT
- Email
- Online Chat
- DO NOT EMAIL
- Video Web Meeting
- USPO
- DO NOT SEND VIDEO
Best Time to Contact
Of the choices below, please select the best time to call.
Your Customer Service Desires
From the choices below, what is most important to you?*
- The Cheapest Price
- Competitive Price
- Quality Insurance Company
- Multiple Product Offering
- Having the right coverage
- Professional Service
- Explanation of Coverage Options
- Trust
- Friendliness of Support Staff
- Multiple Communication Choices (Phone, Text, Chat)
- Office Location
From the choices below, what is NEXT MOST important to you?*
- The Cheapest Price
- Competitive Price
- Quality Insurance Company
- Multiple Product Offering
- Having the right coverage
- Professional Service
- Explanation of Coverage Options
- Trust
- Friendliness of Support Staff
- Multiple Communication Choices (Phone, Text, Chat)
- Office Location
Personalized Policy and Discount Review*
How often would you like us to offer you personalized policy and discount reviews?
Concerns
From the choices below, which could be considered a concern or interest you may have?
Select all that apply.
- Accumulation of Wealth
- Protecting Wealth Against Lawsuits
- Loss of Income Due to Death or Disability
- Evaluating Life Insurance Needs for Loved Ones
- Maximizing Tax Reduction Strategies
- College Funding for Children
- College Funding for Grandchildren
- Proper Distribution of Wealth to Heirs or Charity Upon Death
- Rising Health Insurance Costs
Informative Videos:
From time-to-time (and very seldom), we like to send our clients personalized videos using a link to our client portal. Please let us know if you would like this extra service.
Only remove the check box if you DO NOT wish to receive our very infrequent message. Your selection can be changed at any time.

To see our client portal CLICK HERE
- Explanation of Coverage Options
- Birthday Message
- New Rate or Product Notifications
- Emergency Alert Notification
If there is anything else you would like us to know, please indicate here.

Customer service is the provision of service to customers before, during and after a purchase. Customer service concerns the priority an organization assigns to customer service relative to components such as product innovation and pricing.

Client Preferences

Customer Experience

Preferences

Your Customer Service Desires

Concerns