State Farm applicant exam and interview survey

Name

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Order Number

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Insurance Company

1. Did your State Farm agent or agent’s staff advise you about the telephone interview and examination process?*

2. Was the examination appointment scheduled at a convenient time and place?*

3. Was the examiner courteous and professional?*

4. Did the examiner arrive on time?*

5. Did the examiner weigh you and measure your height?*

6. If your exam was rescheduled for any reason, who needed to reschedule the exam?*

7. How would you rate your overall satisfaction with the exam on a scale from 1 to 5 (5 is extremely satisfied)?*

8. Do you have any suggestions to improve this process?

Please answer the following questions if you completed the medical history interview over the phone. If you have not yet completed the medical history interview or if it was completed online, you may disregard the following questions.

9. The telephone interview questions were clear and easy to understand.

10. The telephone interviewer was courteous and professional.

11. How would you rate your overall satisfaction with the exam on a scale from 1 to 5 (5 is extremely satisfied)?

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