Form 1 Survey

OMB No. 0925–0480; Expires 11/30/06

NATIONAL INSTITUTE OF DIABETES AND
DIGESTIVE AND KIDNEY DISEASES
CUSTOMER SATISFACTION SURVEY
We are interested in learning more about your experience with the Clearinghouse(s) and our materials. Please complete this form
and mail it back—no postage is required. If you prefer to complete this survey online, go to www.catalog.niddk.nih.gov/custsat.
1.

Which Clearinghouse(s) did you contact?
(check all that apply)

7.

❏ Excellent
❏ Above average
❏ Average

❏ National Diabetes Information Clearinghouse (NDIC)
❏ National Digestive Diseases Information
Clearinghouse (NDDIC)
❏ National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC)

8.

❏ Not sure
2.

❏ Internet or email
❏ NIDDK
publications

❏ Newspaper or magazine ❏ Friend or family
❏ Professional meeting
❏ Other (please specify)
___________________
3.

How did you contact the Clearinghouse(s)?
(check all that apply)
❏ Phone
❏ Email
❏ NIDDK website

4.

❏ Mail
❏ Conference/Exhibit
❏ Fax

Including this most recent contact, how many times have you
contacted the Clearinghouse(s) in the last 12 months?
❏ Once
❏ Twice
❏ Three or more times

5.

Please rate the helpfulness of the person with whom you
mostly recently spoke.
❏ Excellent
❏ Above average
❏ Average

6.

❏ Below average
❏ Poor
❏ Not applicable

If you received material in the mail, how soon did you receive
it after ordering?

9.

If you requested information by email, how soon did you get
a response?
❏ 1–4 business days
❏ 5–8 business days
❏ 9 or more business days

10. If you used the NIDDK website, how easy was it to access
information?
❏ Very easy
❏ Somewhat easy
❏ Average

Booklets
Fact sheets
Photocopied articles
Referral to other
organizations

❏ Information over the phone
❏ Other (please specify)
______________________
______________________
❏ Did not receive products
or services

❏ Somewhat difficult
❏ Very difficult

11. Do you have additional comments or suggestions?
____________________________________________________
____________________________________________________
____________________________________________________
12. Please check which category best describes you in your search
for health information.
❏
❏
❏
❏
❏

Dietitian
Educator
Friend or family
Nurse/Nurse Practitioner
Other health professional

What products or services did you receive?
(check all that apply)
❏
❏
❏
❏

❏ Below average
❏ Poor

❏ Less than 3 weeks
❏ 3–5 weeks
❏ Longer than 5 weeks

How did you first hear about the Clearinghouse(s)?
(check all that apply)
❏ Health professional
(physician, nurse,
dietitian, etc.)

Overall, how would you rate the usefulness of the information
you received?

13. I am

❏
❏
❏
❏
❏

❏
❏
❏
❏
❏

Patient
Physician
Student
Writer/Editor
Other (please specify)
___________________

18 years old or younger
19–30 years old
31–55 years old
56–75 years old
76 years old or older

U.S. Department
of Health and
Human Services

For more information or to order additional publications go to www.niddk.nih.gov.

Customer Satisfaction Survey
4 Information Way
Bethesda, MD 20892–3565

Fold along the dotted line and tape closed. Please do not use staples.

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid Office of Management and Budget (OMB) control number. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden,
to NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892–7974, ATTN: PRA (0925–0480).
OMB No. 0925–0480; Expires 11/30/06
Do not return the completed form to the NIH Project Clearance Branch.