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| Welcome and Thank You Text | ||||||
| Welcome Text | Thank You Text | |||||
| Thank you for visiting [Company/Site/Agency]. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. |
Thank you for taking our survey - and for helping us serve you better. We appreciate your input! |
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| Welcome Text - Alternate | Thank You Text - Alternate | |||||
| Thank you for visiting [Company/Site/Agency]. You have been randomly selected to take part in this survey that is being conducted by ForeSee on behalf of the [Company/Site/Agency]. Please take a few minutes to give us your feedback. All results are strictly confidential. | Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site. |
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| Model Name |
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| Model ID | (MID) | Underlined & Italicized: Re-order | ||||||
| Partitioned | Yes | Pink: Addition | ||||||
| Date | (1/2/2013) | Blue: Reword | ||||||
| Label | Element Questions | Label | Satisfaction Questions | Label | Future Behaviors | |||
| Look and Feel (1=Poor, 10=Excellent, Don't Know) | Satisfaction | Return (1=Very Unlikely, 10=Very Likely) | ||||||
| 1 | Look and Feel - Appeal | Please rate the visual appeal of this site. | 16 | Satisfaction - Overall | What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied) |
19 | Return | How likely are you to return to this site? |
| 2 | Look and Feel - Balance | Please rate the balance of graphics and text on this site. | 17 | Satisfaction - Expectations | How well does this site meet your expectations? (1=Falls Short, 10=Exceeds) |
Recommend (1=Very Unlikely, 10=Very Likely) | ||
| 3 | Look and Feel - Readability | Please rate the readability of the pages on this site. | 18 | Satisfaction - Ideal | How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close) |
20 | Recommend | How likely are you to recommend this site to someone else? |
| Site Performance (1=Poor, 10=Excellent, Don't Know) | Primary Resource (1=Very Unlikely, 10=Very Likely) | |||||||
| 4 | Site Performance - Loading | Please rate how quickly pages load on this site. | 21 | Primary Resource | How likely are you to use this site as your primary resource for obtaining information from this organization? | |||
| 5 | Site Performance - Consistency | Please rate the consistency of speed from page to page on this site. | ||||||
| 6 | Site Performance - Completeness | Please rate how completely the page content loads on this site. | ||||||
| Navigation (1=Poor, 10=Excellent, Don't Know) | ||||||||
| 7 | Navigation - Organized | Please rate how well the site is organized. | ||||||
| 8 | Navigation - Options | Please rate the options available for navigating this site. | ||||||
| 9 | Navigation - Layout | Please rate how well the site layout helps you find what you need. | ||||||
| Information Browsing (1=Poor, 10=Excellent, Don't Know) | ||||||||
| 10 | Information Browsing - Sort | Please rate the ability to sort information by criteria that are important to you on this site. | ||||||
| 11 | Information Browsing - Narrow | Please rate the ability to narrow choices to find the information you are looking for on this site. | ||||||
| 12 | Information Browsing - Features | Please rate how well the features on the site help you find the information you need. | ||||||
| Site Information (1=Poor, 10=Excellent, Don't Know) | ||||||||
| 13 | Site Information - Thoroughness | Please rate the thoroughness of information provided on this site. | ||||||
| 14 | Site Information - Understandable | Please rate how understandable this site’s information is. | ||||||
| 15 | Site Information - Answers | Please rate how well the site’s information provides answers to your questions. | ||||||
| Model Name | 0 |
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| Model ID | (MID) | Underlined & Italicized: Re-order | ||||||
| Partitioned | Yes | Pink: Addition | ||||||
| Date | (1/2/2013) | Blue: Reword | ||||||
| QID | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| How often do you visit our site? | First time | Y | Drop down, select one | Visit Frequency | ||||
| Every 6 months or less | ||||||||
| About once a month | ||||||||
| About once a week | ||||||||
| Daily | ||||||||
| More than once a day | ||||||||
| Did you Answer Three Questions (Who are you, Where do you live and What plan are you using) to get your plan info? | Yes | Y | Radio button, one-up vertical | Three Questions | ||||
| No | ||||||||
| Which best describes you? | Active Duty Service Member (includes all Uniformed Services) | N | Y | Radio button, one-up vertical | Skip Logic Group* | Status | ||
| Retired Service Member | P | |||||||
| National Guard or Reserve Member (Active, Reserve or Retired) | Q | |||||||
| Family of Active Duty Service Member | R | |||||||
| Family of Retired Service Member | S | |||||||
| Family of National Guard or Reserve Member | T | |||||||
| Other (Provider, Staff, Government, Media, etc.) | M | |||||||
| M | Please specify. | Provider (Staff included) | Y | Radio button, one-up vertical | Skip Logic Group* | Other Status | ||
| Government | ||||||||
| Government Contractor | ||||||||
| Media | ||||||||
| Other | ||||||||
| N | Which plan are you using? | TRICARE Prime | Y | Radio button, one-up vertical | Skip Logic Group* | Active Duty Plan | ||
| TRICARE Prime Remote | ||||||||
| TRICARE Prime Overseas | ||||||||
| TRICARE Prime Remote Overseas | ||||||||
| Other/Don’t Know | ||||||||
| P | Which plan are you using? | TRICARE Prime | Y | Radio button, one-up vertical | Skip Logic Group* | Retired Plan | ||
| TRICARE Standard and Extra | ||||||||
| TRICARE Standard Overseas | ||||||||
| TRICARE For Life | ||||||||
| US Family Health Plan | ||||||||
| Other/Don’t Know | ||||||||
| Q | Which plan are you using? | TRICARE Prime | Y | Radio button, one-up vertical | Skip Logic Group* | Guard or Reserve Plan | ||
| TRICARE Prime Remote | ||||||||
| TRICARE Prime Overseas | ||||||||
| TRICARE Prime Remote Overseas | ||||||||
| TRICARE Standard and Extra | ||||||||
| TRICARE Standard Overseas | ||||||||
| TRICARE For Life | ||||||||
| TRICARE Reserve Select | ||||||||
| TRICARE Retired Reserve | ||||||||
| US Family Health Plan | ||||||||
| Other/Don’t Know | ||||||||
| R | Which plan are you using? | TRICARE Prime | Y | Radio button, one-up vertical | Skip Logic Group* | Family of Active Duty Plan | ||
| TRICARE Prime Remote | ||||||||
| TRICARE Prime Overseas | ||||||||
| TRICARE Prime Remote Overseas | ||||||||
| TRICARE Standard and Extra | ||||||||
| TRICARE Standard Overseas | ||||||||
| TRICARE Young Adult | ||||||||
| US Family Health Plan | ||||||||
| Other/Don’t Know | ||||||||
| S | Which plan are you using? | TRICARE Prime | Y | Radio button, one-up vertical | Skip Logic Group* | Family of Retired Plan | ||
| TRICARE Standard and Extra | ||||||||
| TRICARE Standard Overseas | ||||||||
| TRICARE For Life | ||||||||
| TRICARE Young Adult | ||||||||
| US Family Health Plan | ||||||||
| Other/Don’t Know | ||||||||
| T | Which plan are you using? | TRICARE Prime | Y | Radio button, one-up vertical | Skip Logic Group* | Family of Guard or Reserve Plan | ||
| TRICARE Prime Remote | ||||||||
| TRICARE Prime Overseas | ||||||||
| TRICARE Prime Remote Overseas | ||||||||
| TRICARE Standard and Extra | ||||||||
| TRICARE Standard Overseas | ||||||||
| TRICARE For Life | ||||||||
| TRICARE Reserve Select | ||||||||
| TRICARE Retired Reserve | ||||||||
| TRICARE Young Adult | ||||||||
| US Family Health Plan | ||||||||
| Other/Don’t Know | ||||||||
| Did you use an interactive tool on our site today? | Yes | A, C | Y | Radio button, one-up vertical | Skip Logic Group* | Tool Interaction | ||
| No | ||||||||
| A | Which tool(s) did you use? Select all that apply. | Covered Services Search Tool | Y | Checkbox, one-up vertical | Skip Logic Group* | Tools Used | ||
| Plan Finder | Randomize | |||||||
| Compare Plans | ||||||||
| Pharmacy Savings Calculator | ||||||||
| Military Hospital and Clinic Locator | ||||||||
| Prime Service Area ZIP Code Tool | ||||||||
| TRICARE Prime Remote ZIP Code Tool | ||||||||
| Frequently Asked Question Database | ||||||||
| Other, please specify | B | Anchor Answer Choice | ||||||
| B | Please specify which tool(s) you used on the site today. | N | Text area, no char limit | Skip Logic Group* | OE_Tools Used | |||
| C | Did you find the tool(s) helpful? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | Tools Helpful | ||
| No | G | |||||||
| G | Please specify why you found the tool(s) unhelpful. | N | Text area, no char limit | Skip Logic Group* | OE_Why Unhelpful | |||
| What were you looking for today? | Plans | Y | Drop down, select one | Skip Logic Group* | Looking For | |||
| What's Covered? | ||||||||
| Find a Doctor | ||||||||
| Costs/Pay a Bill | ||||||||
| Login | ||||||||
| Appointments | ||||||||
| Dental | ||||||||
| Prescriptions | ||||||||
| Claims | ||||||||
| Update Info/ID Cards | ||||||||
| Contact Info | ||||||||
| Other, please specify | E | |||||||
| E | Please specify what you were looking for today. | N | Text area, no char limit | Skip Logic Group* | OE_Looking For | |||
| F | Did you find what you were looking for? | Yes | Y | Radio button, one-up vertical | Did You Find | |||
| No | ||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |