Customer Feedback Form

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Business / Location
Visit / Purchase Date		Order # (optional)
Product or Service Used

What did we do well?
What could we improve?
How did you hear about us?	SearchSocial mediaFriend / familyReview siteWalk-by
Would you use us again?	DefinitelyProbablyNot sureNo

Name		Email
Phone		Contact me about this feedback	YesNo

How to fill out a Customer Feedback Form

Customer Feedback Form template preview — Free Customer Feedback Form template

A customer feedback form helps a business learn what customers think. This one-page survey asks for ratings on key parts of the experience, a 0–10 “would you recommend us” score and open comments about what went well and what could be better.

How to fill it out

Enter your business or location name, and edit the rating rows to match what you want to measure — service, speed, cleanliness, value.
Print a stack for the counter or table, or hand one out at checkout or after a service visit.
Customers rate each area from Poor to Excellent and add a short comment.
They pick a 0–10 score for how likely they are to recommend you, answer what you did well and what to improve, and how they heard about you.
Collect the forms each week and tally the results in a spreadsheet, and follow up with anyone who asked to be contacted.

Tips

Keep it to one page — short forms get far more replies.
Leave a box and pen in a visible spot so people can drop forms in privately.
Let people stay anonymous; contact details are optional on this form.
Reply within a day or two when someone leaves contact details and a complaint.
Track the 0–10 score month to month rather than reading single forms.

Customer Feedback Form example

Business / Location: Maple Street Bakery — Downtown
Order # (optional): 1042
Product or Service Used: Custom birthday cake and coffee

Your Experience

Loved it
A bit pricey
Very kind staff
Online order page was confusing

Tell Us More

What did we do well?: The cake looked exactly like the photo and tasted great. Staff helped carry it to the car.
What could we improve?: Make it easier to pick a pickup time when ordering online.
How did you hear about us?: Friend / family
Would you use us again?: Definitely

Stay in Touch (optional)

Name: Jane Smith
Email: [email protected]
Contact me about this feedback: No

All names, companies and contact details are fictional. Click “Fill sample” above to put this example into the empty fields; click again to remove the parts you did not change.

FAQ

How is the 0–10 score used?

People who answer 9–10 are promoters, 7–8 are passives and 0–6 are detractors. Subtract the percentage of detractors from the percentage of promoters to get a net score from −100 to 100.

Should feedback be anonymous?

Make contact details optional. Anonymous forms usually get more honest answers, and people with a problem can still choose to be contacted.

Can I edit the questions?

Yes. Click any question or label and type over it before printing, and add or remove rating rows.