customer-satisfaction.clingroup.net
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217.160.244.181
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URL:
https://customer-satisfaction.clingroup.net/
Submission: On July 07 via automatic, source certstream-suspicious — Scanned from DE
Submission: On July 07 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
POST https://customer-satisfaction.clingroup.net/home-surveys
<form action="https://customer-satisfaction.clingroup.net/home-surveys" method="post" enctype="multipart/form-data">
<input type="hidden" name="_token" value="Kkkcs9pfugH4wriNriLuhtRcFRdllFJNV294UDeP">
<div class="form-group row">
<label class="col-sm-4 col-form-label">Company Name <span class="required pl-1"> * </span></label>
<div class="col-sm-8">
<input type="text" class="form-control" name="company_name" placeholder="Enter company name" value="" required="">
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">Telephone <span class="required pl-1"> * </span></label>
<div class="col-sm-8">
<input type="text" class="form-control" name="telephone" placeholder="Enter telephone" value="" required="">
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">Fax number </label>
<div class="col-sm-8">
<input type="text" class="form-control" name="fax_number" placeholder="Enter fax number" value="">
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">Nature of business <span class="required pl-1"> * </span></label>
<div class="col-sm-8">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="nature_of_business[]" value="Pharma">
<label class="form-check-label" for="nature_of_business_0">Pharma</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="nature_of_business[]" value="Biotech">
<label class="form-check-label" for="nature_of_business_1">Biotech</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="nature_of_business[]" value="CRO">
<label class="form-check-label" for="nature_of_business_2">CRO</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="nature_of_business[]" value="Hospital">
<label class="form-check-label" for="nature_of_business_3">Hospital</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="nature_of_business[]" value="University">
<label class="form-check-label" for="nature_of_business_4">University</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="nature_of_business[]" value="KOL">
<label class="form-check-label" for="nature_of_business_5">KOL</label>
</div>
<div id="other_option" style="display: none;"></div>
<button type="button" id="add_option" class="btn btn-xs btn-dark mt-2">Add</button>
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">Contact name <span class="required pl-1"> * </span></label>
<div class="col-sm-8">
<input type="text" class="form-control" name="contact_name" placeholder="Enter contact name" value="" required="">
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">Contact position <span class="required pl-1"> * </span></label>
<div class="col-sm-8">
<input type="text" class="form-control" name="contact_position" placeholder="Enter contact position" value="" required="">
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">Contact email <span class="required pl-1"> * </span></label>
<div class="col-sm-8">
<input type="email" class="form-control" name="contact_email" placeholder="Enter contact email" value="" required="">
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">Type of service</label>
<div class="col-sm-8">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="Clinical Studies">
<label class="form-check-label" for="type_of_service_0">Clinical Studies</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="Medical Writing">
<label class="form-check-label" for="type_of_service_1">Medical Writing</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="Training">
<label class="form-check-label" for="type_of_service_2">Training</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="Data Management">
<label class="form-check-label" for="type_of_service_3">Data Management</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="PSP">
<label class="form-check-label" for="type_of_service_4">PSP</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="Staffing">
<label class="form-check-label" for="type_of_service_5">Staffing</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="Logistics">
<label class="form-check-label" for="type_of_service_6">Logistics</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="Regulatory affairs">
<label class="form-check-label" for="type_of_service_7">Regulatory affairs</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="Quality Consultancy, and/or Franchising Consultancy">
<label class="form-check-label" for="type_of_service_8">Quality Consultancy, and/or Franchising Consultancy</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="Pharmacovigilance (PV)">
<label class="form-check-label" for="type_of_service_9">Pharmacovigilance (PV)</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="GxP Audits">
<label class="form-check-label" for="type_of_service_10">GxP Audits</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="type_of_service[]" value="e-Health Solutions">
<label class="form-check-label" for="type_of_service_11">e-Health Solutions</label>
</div>
<div id="type_of_service_other_option" style="display: none;"></div>
<button type="button" id="type_of_service_add_option" class="btn btn-xs btn-dark mt-2"> Add </button>
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label"><strong>Rate Service</strong></label>
<label class="col-sm-8 col-form-label " style=" font-size: 15px;"><strong class="mr-2">1 – Very Unsatisfactory</strong><strong class="mr-2">2 – Unsatisfactory</strong><strong class="mr-2">3 – Satisfactory</strong><strong class="mr-2">4 – Very
Satisfactory</strong></label>
<label class="col-sm-4 col-form-label">How would you rate the quality of our services?</label>
<div class="col-sm-8" style="padding: 15px;">
<div class="d-flex">
<div class="form-check mr-4" style=" font-size: 16px;">
<input class="form-check-input" type="radio" name="quality" value="1">
<label class="form-check-label" for="quality1">1</label>
</div>
<div class="form-check mr-4" style=" font-size: 16px;">
<input class="form-check-input" type="radio" name="quality" value="2">
<label class="form-check-label" for="quality2">2</label>
</div>
<div class="form-check mr-4" style=" font-size: 16px;">
<input class="form-check-input" type="radio" name="quality" value="3">
<label class="form-check-label" for="quality3">3</label>
</div>
<div class="form-check mr-4" style=" font-size: 16px;">
<input class="form-check-input" type="radio" name="quality" value="4">
<label class="form-check-label" for="quality4">4</label>
</div>
</div>
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">How timebound was the delivery of services?</label>
<div class="col-sm-8" style="padding: 15px;">
<div class="d-flex">
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="timebound" value="1">
<label class="form-check-label" for="timebound1">1</label>
</div>
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="timebound" value="2">
<label class="form-check-label" for="timebound2">2</label>
</div>
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="timebound" value="3">
<label class="form-check-label" for="timebound3">3</label>
</div>
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="timebound" value="4">
<label class="form-check-label" for="timebound4">4</label>
</div>
</div>
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">To what extent was the cost effective? (Cost vs. Value)</label>
<div class="col-sm-8" style="padding: 15px;">
<div class="d-flex">
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="cost" value="1">
<label class="form-check-label" for="cost1">1</label>
</div>
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="cost" value="2">
<label class="form-check-label" for="cost2">2</label>
</div>
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="cost" value="3">
<label class="form-check-label" for="cost3">3</label>
</div>
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="cost" value="4">
<label class="form-check-label" for="cost4">4</label>
</div>
</div>
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">Overall satisfaction?</label>
<div class="col-sm-8" style="padding: 15px;">
<div class="d-flex">
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="overall_satisfaction" value="1">
<label class="form-check-label" for="overall_satisfaction1">1</label>
</div>
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="overall_satisfaction" value="2">
<label class="form-check-label" for="overall_satisfaction2">2</label>
</div>
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="overall_satisfaction" value="3">
<label class="form-check-label" for="overall_satisfaction3">3</label>
</div>
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="overall_satisfaction" value="4">
<label class="form-check-label" for="overall_satisfaction4">4</label>
</div>
</div>
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">Would you do business again with ClinGroup and/or recommend its services to others?</label>
<div class="col-sm-8" style="padding: 15px;">
<div class="d-flex">
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="business_again_with_ClinGroup" value="Yes">
<label class="form-check-label" for="business_again_with_ClinGroupyes">Yes</label>
</div>
<div class="form-check mr-4">
<input class="form-check-input" type="radio" name="business_again_with_ClinGroup" value="No">
<label class="form-check-label" for="business_again_with_ClinGroupno">No</label>
</div>
</div>
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">What service would you consider for your upcoming projects?</label>
<div class="col-sm-8">
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="Clinical studies">
<label class="form-check-label" for="service_consider_upcoming_projects_0">Clinical studies</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="Regulatory Affairs">
<label class="form-check-label" for="service_consider_upcoming_projects_1">Regulatory Affairs</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="Data Management">
<label class="form-check-label" for="service_consider_upcoming_projects_2">Data Management</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="Biostatistics">
<label class="form-check-label" for="service_consider_upcoming_projects_3">Biostatistics</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="Medical Writing">
<label class="form-check-label" for="service_consider_upcoming_projects_4">Medical Writing</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="Patient Support Programs (PSP)">
<label class="form-check-label" for="service_consider_upcoming_projects_5">Patient Support Programs (PSP)</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="Pharmacovigilance (PV)">
<label class="form-check-label" for="service_consider_upcoming_projects_6">Pharmacovigilance (PV)</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="E-health solutions">
<label class="form-check-label" for="service_consider_upcoming_projects_7">E-health solutions</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="Training">
<label class="form-check-label" for="service_consider_upcoming_projects_8">Training</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="GxP Audits">
<label class="form-check-label" for="service_consider_upcoming_projects_9">GxP Audits</label>
</div>
<div class="form-check">
<input class="form-check-input" type="checkbox" name="service_consider_upcoming_projects[]" value="QMS Consultancy">
<label class="form-check-label" for="service_consider_upcoming_projects_10">QMS Consultancy</label>
</div>
<div id="service_consider_upcoming_projects_other_option" style="display: none;"></div>
<button type="button" id="service_consider_upcoming_projects_add_option" class="btn btn-xs btn-dark mt-2">Add </button>
<span class="text-danger"></span>
</div>
</div>
<div class="form-group row">
<label class="col-sm-4 col-form-label">Comments</label>
<div class="col-sm-8">
<textarea type="text" class="form-control" name="comments" placeholder="Enter comments"></textarea>
<span class="text-danger"></span>
</div>
</div>
<div class="form-group" style="text-align: -webkit-center; float: right;">
<div style="" class="form-group g-recaptcha" data-sitekey="6LdIdTgiAAAAAJKrb69Mv-XtjRW5S7-8TUyxSBsr">
<div style="width: 304px; height: 78px;">
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</div><iframe style="display: none;"></iframe>
</div>
</div>
<button type="submit" class="btn btn-xs btn-dark mt-5 mb-5">Submit</button>
</form>Text Content
CUSTOMER SATISFACTION SURVEY -------------------------------------------------------------------------------- Company Name * Telephone * Fax number Nature of business * Pharma Biotech CRO Hospital University KOL Add Contact name * Contact position * Contact email * Type of service Clinical Studies Medical Writing Training Data Management PSP Staffing Logistics Regulatory affairs Quality Consultancy, and/or Franchising Consultancy Pharmacovigilance (PV) GxP Audits e-Health Solutions Add Rate Service 1 – Very Unsatisfactory2 – Unsatisfactory3 – Satisfactory4 – Very Satisfactory How would you rate the quality of our services? 1 2 3 4 How timebound was the delivery of services? 1 2 3 4 To what extent was the cost effective? (Cost vs. Value) 1 2 3 4 Overall satisfaction? 1 2 3 4 Would you do business again with ClinGroup and/or recommend its services to others? Yes No What service would you consider for your upcoming projects? Clinical studies Regulatory Affairs Data Management Biostatistics Medical Writing Patient Support Programs (PSP) Pharmacovigilance (PV) E-health solutions Training GxP Audits QMS Consultancy Add Comments Submit Copyright ©2024 All rights reserved - ClinGroup * * *