Name
First Name
Last Name
Email
example@example.com
Inputs
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Service Quality
Cleanliness
Responsiveness
Friendliness
Radio
Type option 1
Type option 2
Type option 3
Type option 4
Checkbox
Type option 1
Type option 2
Type option 3
Type option 4
Submit
Should be Empty: