Questionnaire template
Service Request (Request forms)
Captures a customer's service type, problems, severity, urgency and contact preferences to route a technical service request.
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Other · Request forms. All Other templates
Questions in this template
Your Service Need
Please tell us about the service you need. Your answers help us send the right people and arrange a suitable time.
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What type of service do you need?
Choose one:
- Maintenance
- Installation
- Upgrade
- Consulting
- Other
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What service do you need?
Condition: Shown when Other is selected
Open answer
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Which problems are you experiencing?
Choose any that apply:
- Slow performance
- Frequent breakdowns
- Compatibility problems
- Unreliable service
- Something else
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Please add any detail about the problems you selected.
Condition: Shown when at least one problem was selected
Open answer
About the Problem
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Overall, how serious is the problem?
Choose one:
- Mild
- Moderate
- Severe
- Very severe
- Critical
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Describe what is happening, including when it started.
Open answer
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How soon do you need this resolved?
Choose one:
- Very urgent
- Urgent
- Moderately urgent
- Slightly urgent
- Not urgent
Contact and Scheduling
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Which phone number is best for reaching you?
Open answer
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On which date would you prefer the service team to help you?
Open answer
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Which time of day suits you best?
Choose one:
- Morning
- Afternoon
- Evening
- Any time