{"id":14258,"date":"2024-05-14T09:31:18","date_gmt":"2024-05-14T07:31:18","guid":{"rendered":"https:\/\/www.varodem.com\/klanttevredenheidsonderzoek\/"},"modified":"2026-05-12T08:57:15","modified_gmt":"2026-05-12T06:57:15","slug":"klanttevredenheidsonderzoek","status":"publish","type":"page","link":"https:\/\/www.varodem.com\/en\/klanttevredenheidsonderzoek\/","title":{"rendered":"Customer Satisfaction Survey"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"14258\" class=\"elementor elementor-14258 elementor-5433\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-fc1cd04 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"fc1cd04\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-53d68cc\" data-id=\"53d68cc\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a7e1dc5 elementor-widget elementor-widget-text-editor\" data-id=\"a7e1dc5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span class=\"selectable-text copyable-text\">At Varodem, we regularly assess our customer focus. We do this by conducting customer satisfaction surveys. Using this online questionnaire, you\u2014whether you\u2019re a customer, a healthcare provider, or a user of our medical compression devices\u2014can share your feedback with us. If you use our form anonymously, we will not be able to respond to the content of your answers. If you would like us to do so, please provide your contact information.    <\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e8c3579 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"e8c3579\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-eb0c9f2 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"eb0c9f2\" 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method='post' enctype='multipart\/form-data'  id='gform_10'  action='\/en\/wp-json\/wp\/v2\/pages\/14258' data-formid='10' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_10_46\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_46'>Comments<\/label><div class='ginput_container'><input name='input_46' id='input_10_46' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_10_46'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_10_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you filling out this form anonymously?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_16'>\n\t\t\t<div class='gchoice gchoice_10_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Yes'  id='choice_10_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_16_0' id='label_10_16_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='No'  id='choice_10_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_16_1' id='label_10_16_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_1'>\n                            \n                            <span id='input_10_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_10_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_10_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_10_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_10_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_10_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_2'>Email address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_10_2' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                        <\/div><\/div><div id=\"field_10_3\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_3'>Company name \/ Practice name<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_10_3' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_18\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_18'>In what capacity are you filling out this form?<\/label><div class='ginput_container ginput_container_select'><select name='input_18' id='input_10_18' class='large gfield_select'  aria-describedby=\"gfield_description_10_18\"   aria-invalid=\"false\" ><option value='Supplier' >Supplier<\/option><option value='End User' >End User<\/option><option value='Caregiver' >Caregiver<\/option><option value='Caregiver - therapist' >Caregiver &#8211; therapist<\/option><option value='Health care provider - physician' >Health care provider &#8211; physician<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_10_18'>We would like to know your relationship to our medical compression devices.<\/div><\/div><fieldset id=\"field_10_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you ordered a product from Varodem in the past 12 months?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_19'>\n\t\t\t<div class='gchoice gchoice_10_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_10_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_19_0' id='label_10_19_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_10_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_19_1' id='label_10_19_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have experiences with medical compression devices from Varodem?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_21'>\n\t\t\t<div class='gchoice gchoice_10_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Yes'  id='choice_10_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_21_0' id='label_10_21_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='No'  id='choice_10_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_21_1' id='label_10_21_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have experiences with therapeutic elastic stockings with seam (flat-knit) from Varodem?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_22'>\n\t\t\t<div class='gchoice gchoice_10_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Yes'  id='choice_10_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_22_0' id='label_10_22_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='No'  id='choice_10_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_22_1' id='label_10_22_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have experiences with therapeutic elastic stockings without a seam (Circular-knit) from Varodem?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_23'>\n\t\t\t<div class='gchoice gchoice_10_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Yes'  id='choice_10_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_23_0' id='label_10_23_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No'  id='choice_10_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_23_1' id='label_10_23_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have experience with the VaroCare Wrap bandage system with Velcro?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_24'>\n\t\t\t<div class='gchoice gchoice_10_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Yes'  id='choice_10_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_24_0' id='label_10_24_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='No'  id='choice_10_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_24_1' id='label_10_24_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have experience with Curetex compression bandages?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_25'>\n\t\t\t<div class='gchoice gchoice_10_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Yes'  id='choice_10_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_25_0' id='label_10_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No'  id='choice_10_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_25_1' id='label_10_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_44\" class=\"gfield gfield--type-post_title gfield--input-type-post_title gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_44'>Please indicate your satisfaction with our service on the following topics:<\/label><div class='ginput_container ginput_container_post_title'>\n\t\t\t\t\t<input name='input_44' id='input_10_44' type='text' value='' class='large'    aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/div><fieldset id=\"field_10_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >general<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_35'>\n\t\t\t<div class='gchoice gchoice_10_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Very satisfied'  id='choice_10_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_35_0' id='label_10_35_0' class='gform-field-label gform-field-label--type-inline'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Satisfied'  id='choice_10_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_35_1' id='label_10_35_1' class='gform-field-label gform-field-label--type-inline'>Satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_35_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Neutral'  id='choice_10_35_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_35_2' id='label_10_35_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_35_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Disgruntled'  id='choice_10_35_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_35_3' id='label_10_35_3' class='gform-field-label gform-field-label--type-inline'>Disgruntled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_35_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Very dissatisfied'  id='choice_10_35_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_35_4' id='label_10_35_4' class='gform-field-label gform-field-label--type-inline'>Very dissatisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_41\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Our information offer<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_41'>\n\t\t\t<div class='gchoice gchoice_10_41_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='Very satisfied'  id='choice_10_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_41_0' id='label_10_41_0' class='gform-field-label gform-field-label--type-inline'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_41_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='Satisfied'  id='choice_10_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_41_1' id='label_10_41_1' class='gform-field-label gform-field-label--type-inline'>Satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_41_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='Neutral'  id='choice_10_41_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_41_2' id='label_10_41_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_41_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='Disgruntled'  id='choice_10_41_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_41_3' id='label_10_41_3' class='gform-field-label gform-field-label--type-inline'>Disgruntled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_41_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='Very dissatisfied'  id='choice_10_41_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_41_4' id='label_10_41_4' class='gform-field-label gform-field-label--type-inline'>Very dissatisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_40\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Our delivery times<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_40'>\n\t\t\t<div class='gchoice gchoice_10_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Very satisfied'  id='choice_10_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_40_0' id='label_10_40_0' class='gform-field-label gform-field-label--type-inline'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Satisfied'  id='choice_10_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_40_1' id='label_10_40_1' class='gform-field-label gform-field-label--type-inline'>Satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_40_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Neutral'  id='choice_10_40_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_40_2' id='label_10_40_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_40_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Disgruntled'  id='choice_10_40_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_40_3' id='label_10_40_3' class='gform-field-label gform-field-label--type-inline'>Disgruntled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_40_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Very dissatisfied'  id='choice_10_40_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_40_4' id='label_10_40_4' class='gform-field-label gform-field-label--type-inline'>Very dissatisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_39\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Our response time<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_39'>\n\t\t\t<div class='gchoice gchoice_10_39_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Very satisfied'  id='choice_10_39_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_39_0' id='label_10_39_0' class='gform-field-label gform-field-label--type-inline'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_39_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Satisfied'  id='choice_10_39_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_39_1' id='label_10_39_1' class='gform-field-label gform-field-label--type-inline'>Satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_39_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Neutral'  id='choice_10_39_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_39_2' id='label_10_39_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_39_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Disgruntled'  id='choice_10_39_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_39_3' id='label_10_39_3' class='gform-field-label gform-field-label--type-inline'>Disgruntled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_39_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Very dissatisfied'  id='choice_10_39_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_39_4' id='label_10_39_4' class='gform-field-label gform-field-label--type-inline'>Very dissatisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_42\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Return service<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_42'>\n\t\t\t<div class='gchoice gchoice_10_42_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Very satisfied'  id='choice_10_42_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_42_0' id='label_10_42_0' class='gform-field-label gform-field-label--type-inline'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_42_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Satisfied'  id='choice_10_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_42_1' id='label_10_42_1' class='gform-field-label gform-field-label--type-inline'>Satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_42_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Neutral'  id='choice_10_42_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_42_2' id='label_10_42_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_42_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Disgruntled'  id='choice_10_42_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_42_3' id='label_10_42_3' class='gform-field-label gform-field-label--type-inline'>Disgruntled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_42_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Very dissatisfied'  id='choice_10_42_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_42_4' id='label_10_42_4' class='gform-field-label gform-field-label--type-inline'>Very dissatisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Our helpfulness<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_43'>\n\t\t\t<div class='gchoice gchoice_10_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Very satisfied'  id='choice_10_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_43_0' id='label_10_43_0' class='gform-field-label gform-field-label--type-inline'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Satisfied'  id='choice_10_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_43_1' id='label_10_43_1' class='gform-field-label gform-field-label--type-inline'>Satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_43_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Neutral'  id='choice_10_43_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_43_2' id='label_10_43_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_43_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Disgruntled'  id='choice_10_43_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_43_3' id='label_10_43_3' class='gform-field-label gform-field-label--type-inline'>Disgruntled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_43_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Very dissatisfied'  id='choice_10_43_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_43_4' id='label_10_43_4' class='gform-field-label gform-field-label--type-inline'>Very dissatisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_26\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Would you recommend Varodem to acquaintances, colleagues, family and\/or friends?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_26'><div class='gchoice gchoice_10_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='Yes'  id='choice_10_26_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_26_1' id='label_10_26_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='No'  id='choice_10_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_26_2' id='label_10_26_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_45\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_45'>What rating would you give Varodem (from 0 to 10)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_45' id='input_10_45' type='number' step='any' min='0' max='10' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_10_45\" \/><div class='gfield_description instruction ' id='gfield_instruction_10_45'>Please enter a number from <strong>0<\/strong> to <strong>10<\/strong>.<\/div><\/div><\/div><div id=\"field_10_37\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_37'>If you have additional comments, questions or information, please provide it below.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_37' id='input_10_37' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_10' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Send'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_10' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_10' id='gform_theme_10' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_10' id='gform_style_settings_10' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_10' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='10' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' value='QOWEuIBrho0gjK6VxNu1iuZhIbYuxCk7wdG9yNkkTnr3foYvrAcGLu\/NmPXRLRaDfaoO0uIiMFnJ\/90a3upk\/CZLK\/Db0nwzag+qXbPZSFOeDk0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_10' 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