For Men

How To Become A Sperm Donor

Donor Online Application

How To Bank Your Own Sperm Now For Future Use

Let Us Know How We're Doing

In an effort to provide the best possible experience with Pacific Reproductive Services, we would appreciate your response to the following items. If web security is a concern to you, please print our PDF form and mail it to us c/o M. Oddone, Director of Marketing, 444 De Haro St., Suite 222, San Francisco, CA 94107. Thank you.

Please continue by filling out the following fields:

1. Why did you contact Pacific Reproductive Services?

	Purchase sperm
	Insemination services
	Infertility consulting
	Become a donor
	Store sperm
	Needed more information
	Other

2. How did you first contact us?

	Phone
	Website
	E-mail
	Fax
	Mail
	In-Person
	Other

3. How long did you have to wait before a customer representative addressed your needs?

	Right away
	Later that same day
	Next day
	2-4 days
	5-7 days
	More than a week
	Other

4. How long have you been a Pacific Reproductive Services customer?

	Less than 6 months
	6 months - 1 year
	2-4 years
	More than 5 Years

5. How often have you had contact with Pacific Reproductive Services in the past 3 months?

	Once
	2-5 times
	5-10 times
	10-30 times
	Daily

6. Where did you look for information on sperm banks?

	Physician or other health professional
	Internet
	Yellow Pages
	Friend
	Book/Resource
	Media Story
	Other

7. Which of the following most influenced your choice?

	Company has a good reputation
	Physician or health professional reference
	Friend or family used the same company
	Magazine or publication article
	Customer service
	Competitive rates & fees
	Good donor selection
	Availability of "Willing to Be Known" donors
	Many years in the business
	Accreditations
	Website
	Convenient location

8. Please rate the following statements according to your experience with both Pacific Reproductive Services and the Pacific Reproductive Services' Customer Service Representatives (CSR's):

	Agree	Neutral	Disagree	N/A
My request was processed promptly
My request was processed accurately
My questions were answered fully
The CSR was knowledgable
The CSR was courteous
The CSR was professional
The CSR showed initiative in helping
I was able to access information that I needed from the website
The website is easy to use and well-organized
The website contains clear and accurate information
If I recieved printed information, it was clear and understandable

9. Please rate our products and services

	Poor	Fair	Good	Very Good	Excellent	N/A
Selection of donors
Registration
Initial consultation
Website
Customer Service
Professional advice
Medical screening

10. Based on your experience with Pacific Reproductive Services, would you recommend our services to others and use our services again in the future?

	Yes
	No
	Not applicable

11. What can we do better?

12. What are we doing right?

13. How would you rate our service now, compared to previous experience?

	Significantly better
	A little better
	Same as before
	Worse
	A lot worse
	Not applicable, my first experience

Contact Information:

Your Name:
Telephone Number (XXX-XXX-XXXX):
Email Address: (user@domain.com)
Your Customer Service Representative:

May we print your comments?

	Yes
	No

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