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State Farm applicant survey

Thank you for completing your Personal History Questionnaire. We would appreciate your feedback so we can continue to better serve life insurance applicants.

State Farm applicant survey

Name (Prefix)
Name (First)
Name (Middle)
Name (Last)
Name (Suffix)
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Insurance Company
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Ticket Number
1. How did you learn about the online Personal History Questionnaire option?*
2. Please rate your experience with accessing and signing in to the online Personal History Questionnaire?*
3. How would you rate the online Personal History Questionnaire questions?*
4. Please rate your satisfaction with the time it took to complete the online Personal History Questionnaire.*
5. If you scheduled your exam appointment online, please rate your overall satisfaction with the process. If you did not use this feature or if it does not apply to you, please select ‘N/A’.
6. Please rate your overall satisfaction with the online Personal History Questionnaire experience.*
7. How likely are you to recommend State Farm Life insurance to another family member/acquaintance?*
8. Do you have any suggestions to improve the online Personal History Questionnaire process?
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Order Number
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