Customer Feedback Survey Form

A customer feedback survey to measure satisfaction, Net Promoter Score (NPS), key touchpoint experiences, and open-ended recommendations.

About Your Experience

• What type of experience are you reviewing?
• When did this experience occur?
  Optional. Helps us identify the interaction you are referring to.
• Where did this happen?
  Optional. For example: website, phone, store location, app, or email.

Overall Satisfaction

• Overall, how satisfied were you with your experience?
• How likely are you to recommend us to a friend or colleague?
• What is the main reason for your score?

Key Touchpoints

• How easy was it to complete what you needed to do?
• How helpful was our team or representative?
• How satisfied were you with the speed or timeliness of the experience?
• Which parts of the experience should we improve?

Open Feedback

• What did we do well?
• What could we do better?
• May we contact you if we need clarification about your feedback?
  Optional. If you choose yes, you can provide contact details below for follow-up.
• Email address
  Optional. Only provide this if you want us to follow up about your feedback.