Q01
Message
All templatesFinance & Insurance
Insurance Agent Performance & Trust Evaluation
Measures how policyholders experience their insurance agent — responsiveness, product knowledge, coverage fit, and claims support — with an AI follow-up that digs into the specific moment that shaped their trust (or distrust) in the agent. Built for agencies and carriers running periodic agent scorecards.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
14 questions · ~7 min
Q02
Multiple ChoiceRequired
Which type(s) of insurance does this agent handle for you?
- Auto
- Home or property
- Life
- Health
- Business
- Umbrella or other
Q03
Multiple ChoiceRequired
In the last 12 months, how many times have you contacted this agent (calls, emails, texts, or in-person)?
- None
- 1-2 times
- 3-5 times
- 6 or more times
Q04
MatrixRequired
Based on your experience, how would you rate your agent on each of the following?
5 rows × 5 columns
- Knowledge of insurance products
- Clarity of explanations
- Responsiveness to your questions
- Professionalism
- Honesty and trustworthiness
Columns: Poor · Fair · Good · Very good · Excellent
Q05
Opinion ScaleRequired
Overall, how satisfied are you with this agent?
Scale: 1 – 5
Min:Very dissatisfiedMax:Very satisfied
Q06
Opinion ScaleRequired
How likely are you to recommend this agent to a friend or family member?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q07
Multiple ChoiceRequired
Thinking about the coverage your agent recommended, how well did it match your actual needs?
- Matched my needs well
- I felt over-insured (paying for more than I need)
- I felt under-insured (gaps in my coverage)
- Not sure / never discussed in detail
Q08
Multiple Choice
If you filed a claim in the last 12 months, how would you rate the agent's support during that process?
- Excellent support, they advocated for me
- Good support, but slow at times
- Poor support, I felt on my own
- Haven't filed a claim in the last 12 months
Q09
AI Interview
Reconstruct the specific interaction or decision that most shaped this respondent's trust in their agent. Anchor on their recommendation score and coverage-fit answer: if the score is low or they felt over/under-insured, probe exactly what happened, what the agent said or failed to say, and whether they've considered switching agents or carriers. If the score is high, find the one moment that earned that trust so it can be replicated by other agents.
Q10
Multiple ChoiceRequired
How likely are you to continue using this agent for your insurance needs next year?
- Very likely
- Somewhat likely
- Unsure
- Somewhat unlikely
- Very unlikely
Q11
Multiple Choice
How long has this person been your insurance agent?
- Less than 1 year
- 1-3 years
- 4-9 years
- 10+ years
- Not sure
Q12
Multiple Choice
Which age group do you fall into?
- Under 25
- 25-34
- 35-44
- 45-54
- 55-64
- 65 or older
- Prefer not to say
Q13
Multiple Choice
How do you describe your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q14
Message
Thank you for sharing your experience! Your feedback goes directly into your agent's coaching and recognition review — it's never shared with them word-for-word, but the patterns you helped surface are.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Includes a dedicated AI follow-up interview that reconstructs the specific interaction or decision that shaped the policyholder's trust (or distrust), not just a rating.
- Combines structured measurement (matrix ratings on responsiveness, product knowledge, coverage fit, claims support) with open-ended adaptive probing in one flow.
- Captures coverage-fit and claims-support perception directly, plus satisfaction, NPS-style likelihood to recommend, and retention intent — giving agencies a full scorecard, not a single-metric survey.
- Auto-generates a per-response report so agencies can review individual agent feedback without manually reading transcripts.
QuestionPro
Insurance agent survey questions + sample questionnaire templateThis is a questionnaire/sample-questions page for insurance agent evaluation rather than a single ready-to-field template with a fixed flow. It covers the same general subject matter (agent evaluation) and gives question ideas, but appears to function more as a guide plus a customizable builder than a packaged survey with built-in analysis.
What it does well
- Directly focused on the insurance agent evaluation use case
- Backed by a large established survey platform with broad customization and distribution tools
- Provides sample questions that can be a useful starting reference for question wording
Where it falls short
- Presented as sample questions/guide content rather than a fielding-ready template with a fixed structure
- No adaptive AI follow-up — cannot dynamically probe the specific moment that shaped a policyholder's trust
- No automated per-response quality scoring or auto-generated agent-level report mentioned
Jotform
Agent Performance Evaluation Form TemplateThis is a generic agent performance evaluation form, not specific to insurance agents, coverage fit, or claims support. It's ready to field as a form but is a static questionnaire built for broad 'agent' use cases rather than insurance-specific trust and product-knowledge dynamics.
What it does well
- Ready-to-use, easily editable form builder with drag-and-drop customization
- Generic enough to be adapted across different agent-type contexts
- Simple, familiar form format for quick deployment
Where it falls short
- Not insurance-specific — lacks built-in items on coverage fit, claims support, or product knowledge
- Static form with no adaptive AI follow-up to probe the specific interaction that shaped trust
- No automated quality scoring or auto-generated report; results require manual review
Frequently asked questions
What questions are in the “Insurance Agent Performance & Trust Evaluation” template?
The template includes 14 ready-to-use questions, starting with: “Hi! We'd like your honest feedback on the insurance agent who handles your policy. Your responses are completely confide…” · “Which type(s) of insurance does this agent handle for you?” · “In the last 12 months, how many times have you contacted this agent (calls, emails, texts, or in-person)?”. The full set is previewed above, and every question is editable.
How long does this survey take to complete?
Respondents typically finish the 14 questions in about 7 minutes.
Can I customize this template?
Yes — every question, answer option, and the ordering is editable before you launch. You can add or remove questions, or ask the AI editor to rework the survey around your research goal.
Is this template free to use?
Yes. Open it in the editor and start customizing right away — no account required to try it, and the free plan covers launching your survey.
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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