&lt;form id=&quot;form-app&quot;&gt;
&lt;fieldset&gt;

&lt;!-- Heading --&gt;
&lt;h3 class=&quot;legend&quot;&gt;Customer Satisfaction Survey&lt;/h3&gt;

&lt;!-- Paragraph Text --&gt;
&lt;p&gt;Please take a few moments to complete this satisfaction survey.&lt;/p&gt;

&lt;!-- Radio --&gt;
&lt;div class=&quot;form-group&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;radio_0&quot;&gt;Overall, how satisfied were you with the product / service?&lt;/label&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_0_0&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_0&quot; id=&quot;radio_0_0&quot; value=&quot;Very Satisfied&quot;&gt; Very Satisfied &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_0_1&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_0&quot; id=&quot;radio_0_1&quot; value=&quot;Satisfied&quot;&gt; Satisfied &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_0_2&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_0&quot; id=&quot;radio_0_2&quot; value=&quot;Neutral&quot;&gt; Neutral &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_0_3&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_0&quot; id=&quot;radio_0_3&quot; value=&quot;Unsatisfied&quot;&gt; Unsatisfied &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_0_4&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_0&quot; id=&quot;radio_0_4&quot; value=&quot;Very Unsatisfied&quot;&gt; Very Unsatisfied &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_0_5&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_0&quot; id=&quot;radio_0_5&quot; value=&quot;N/A&quot;&gt; N/A &lt;/label&gt;
    &lt;/div&gt;
    &lt;span id=&quot;radio_0&quot;&gt;&lt;/span&gt;
&lt;/div&gt;

&lt;!-- Radio --&gt;
&lt;div class=&quot;form-group&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;radio_1&quot;&gt;Would you recommend our product / service to colleagues or contacts within your industry?&lt;/label&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_1_0&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_1&quot; id=&quot;radio_1_0&quot; value=&quot;Definitely&quot;&gt; Definitely &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_1_1&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_1&quot; id=&quot;radio_1_1&quot; value=&quot;Probably&quot;&gt; Probably &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_1_2&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_1&quot; id=&quot;radio_1_2&quot; value=&quot;Not Sure&quot;&gt; Not Sure &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_1_3&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_1&quot; id=&quot;radio_1_3&quot; value=&quot;Probably Not&quot;&gt; Probably Not &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_1_4&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_1&quot; id=&quot;radio_1_4&quot; value=&quot;Definitely Not&quot;&gt; Definitely Not &lt;/label&gt;
    &lt;/div&gt;
    &lt;span id=&quot;radio_1&quot;&gt;&lt;/span&gt;
&lt;/div&gt;

&lt;!-- Radio --&gt;
&lt;div class=&quot;form-group&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;radio_2&quot;&gt;Would you use our product / service in the future?&lt;/label&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_2_0&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_2&quot; id=&quot;radio_2_0&quot; value=&quot;Less than a month&quot;&gt; Less than a month &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_2_1&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_2&quot; id=&quot;radio_2_1&quot; value=&quot;1-6 months&quot;&gt; 1-6 months &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_2_2&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_2&quot; id=&quot;radio_2_2&quot; value=&quot;1-3 years&quot;&gt; 1-3 years &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_2_3&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_2&quot; id=&quot;radio_2_3&quot; value=&quot;Over 3 Years&quot;&gt; Over 3 Years &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_2_4&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_2&quot; id=&quot;radio_2_4&quot; value=&quot;Never used&quot;&gt; Never used &lt;/label&gt;
    &lt;/div&gt;
    &lt;span id=&quot;radio_2&quot;&gt;&lt;/span&gt;
&lt;/div&gt;

&lt;!-- Radio --&gt;
&lt;div class=&quot;form-group&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;radio_3&quot;&gt;How often do you use product / service?&lt;/label&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_3_0&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_3&quot; id=&quot;radio_3_0&quot; value=&quot;Once a week&quot;&gt; Once a week &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_3_1&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_3&quot; id=&quot;radio_3_1&quot; value=&quot;2 to 3 times a month&quot;&gt; 2 to 3 times a month &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_3_2&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_3&quot; id=&quot;radio_3_2&quot; value=&quot;Once a month&quot;&gt; Once a month &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_3_3&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_3&quot; id=&quot;radio_3_3&quot; value=&quot;Less than once a month&quot;&gt; Less than once a month &lt;/label&gt;
    &lt;/div&gt;
    &lt;span id=&quot;radio_3&quot;&gt;&lt;/span&gt;
&lt;/div&gt;

&lt;!-- Radio --&gt;
&lt;div class=&quot;form-group&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;radio_4&quot;&gt;What aspect of the product / service were you most satisfied by?&lt;/label&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_4_0&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_4&quot; id=&quot;radio_4_0&quot; value=&quot;Quality&quot;&gt; Quality &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_4_1&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_4&quot; id=&quot;radio_4_1&quot; value=&quot;Price&quot;&gt; Price &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_4_2&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_4&quot; id=&quot;radio_4_2&quot; value=&quot;Purchase Experience&quot;&gt; Purchase Experience &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_4_3&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_4&quot; id=&quot;radio_4_3&quot; value=&quot;Installation or First Use Experience&quot;&gt; Installation or First Use Experience &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_4_4&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_4&quot; id=&quot;radio_4_4&quot; value=&quot;Usage Experience&quot;&gt; Usage Experience &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_4_5&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_4&quot; id=&quot;radio_4_5&quot; value=&quot;Customer Service&quot;&gt; Customer Service &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_4_6&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_4&quot; id=&quot;radio_4_6&quot; value=&quot;Repeat Purchase Experience&quot;&gt; Repeat Purchase Experience &lt;/label&gt;
    &lt;/div&gt;
    &lt;span id=&quot;radio_4&quot;&gt;&lt;/span&gt;
&lt;/div&gt;

&lt;!-- Text Area --&gt;
&lt;div class=&quot;form-group&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;textarea_0&quot;&gt;What do you like about the product / service?&lt;/label&gt;
    &lt;textarea id=&quot;textarea_0&quot; name=&quot;textarea_0&quot; rows=&quot;3&quot; class=&quot;form-control&quot;&gt;&lt;/textarea&gt;
&lt;/div&gt;

&lt;!-- Text Area --&gt;
&lt;div class=&quot;form-group&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;textarea_1&quot;&gt;What do you dislike about the product / service?&lt;/label&gt;
    &lt;textarea id=&quot;textarea_1&quot; name=&quot;textarea_1&quot; rows=&quot;3&quot; class=&quot;form-control&quot;&gt;&lt;/textarea&gt;
&lt;/div&gt;

&lt;!-- Radio --&gt;
&lt;div class=&quot;form-group&quot;&gt;
    &lt;label class=&quot;control-label&quot; for=&quot;radio_5&quot;&gt;Thinking of similar products / services offered by other companies, how would you compare the product / service offered by our company?&lt;/label&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_5_0&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_5&quot; id=&quot;radio_5_0&quot; value=&quot;Much Better&quot;&gt; Much Better &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_5_1&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_5&quot; id=&quot;radio_5_1&quot; value=&quot;Somewhat Better&quot;&gt; Somewhat Better &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_5_2&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_5&quot; id=&quot;radio_5_2&quot; value=&quot;About the Same&quot;&gt; About the Same &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_5_3&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_5&quot; id=&quot;radio_5_3&quot; value=&quot;Somewhat Worse&quot;&gt; Somewhat Worse &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_5_4&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_5&quot; id=&quot;radio_5_4&quot; value=&quot;Much Worse&quot;&gt; Much Worse &lt;/label&gt;
    &lt;/div&gt;
    &lt;div class=&quot;radio&quot;&gt;
        &lt;label for=&quot;radio_5_5&quot; class=&quot;radio-inline&quot;&gt;
        &lt;input type=&quot;radio&quot; name=&quot;radio_5&quot; id=&quot;radio_5_5&quot; value=&quot;Don&#039;t Know&quot;&gt; Don&#039;t Know &lt;/label&gt;
    &lt;/div&gt;
    &lt;span id=&quot;radio_5&quot;&gt;&lt;/span&gt;
&lt;/div&gt;

&lt;!-- Button --&gt;
&lt;div class=&quot;form-action&quot;&gt;
    &lt;input type=&quot;submit&quot; id=&quot;button_0&quot; name=&quot;button_0&quot; class=&quot;btn btn-primary&quot; value=&quot;Submit&quot;&gt;
&lt;/div&gt;

&lt;/fieldset&gt;
&lt;/form&gt;