CUSTOMER COMPLAINT AND FEEDBACK MONITORING REQUIREMENT FOR MY GIFT SHOP

I have a gift shop named “JUST FOR YOU”. In order to know my store’s performance, I need feedback from my customers. I also want to give them a chance to post their complaints and suggestions for my shop. Henceforth, my requirements are as follows.

Customer information:

First Name: 

Middle name:

Last name:

Gender:  ( radio button : male/famle)

Address:

Contact no.:

Email id:

QUESTIONER

Type of feedback:(dropdown)

• Bug Report
• Suggestion

1. Did u enjoy shopping at our store? (radio button)

·         Yes

·         No

2. Did u get what you wanted? ( radio button)

·         Yes

·         No

3. If the option chosen in above question is "no" then only show this question.      
 Item what you wanted:

If ‘yes’, do not show question 3,shift to question 4

4. What was your level of satisfaction? (radio button)

·         Excellent

·         Good

·         Satisfactory

·         Bad

·         Very bad

5. What did you like most about the shop? (checkbox)

·         Collection of gift items

·         Price

·         Atmosphere of shop

·         Service provided

·   

6. Are you satisfied with the sales person who attended you? ( radio button)

·         Yes

·         No

7. From where did you come to know about the shop? (checkbox)

·         Friends

·         Relatives

·         Internet

·         Magazine

·         Newspaper  ad

·         Television ad

8. Will you refer “Just For You” to someone else? (radio button)

·         Yes

·         no

9. Any complaints?

 (Dialogue box)

10. Any suggestion for improvement at our store?

(Dialogue box)

A confirmation message will go to the customer's mail id, once the form is filled. I want to receive a mail each time a customer fills in the form notifying the type of feedback.