Customer feedback form template

Feedback after a visit, job or purchase: an overall rating first, the parts that matter, one thing to fix, and contact details only from people who want a reply.

Use this template

Preview · answers aren’t saved

Question 1 of 5

Overall, how satisfied were you? (required)

Scale from 1 (Not at all) to 5 (Very)

11 questions · about 1 min · logic · prefill from the link

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Unlimited responses on Free

Print it as a PDF Word version

Change the questions in Word, then print.

What you get back

Every response lands in your results the moment it is sent. Turn on email notifications and each one arrives like this, and the same answers become a row in your spreadsheet.

From PulseFormCreator

Subject New response to Tell us how we did

Overall, how satisfied were you?: 4
When did you visit? (optional): 20 Sep 2026
How did we do on…: Food or product: Excellent; Service: Very good; Cleanliness: Good; Value for money: Very good
What’s one thing we could do better?: More seats outside on weekends. We waited ten minutes for a table in the sun.
Who served you? (optional): Jess
Quote: Yes

and 1 more answers

A sample email with made-up answers.

submitted_at	Overall, how satisfied were you?	When did you visit? (optional)	How did we do on…	Sorry to hear that. What went wrong?	What’s one thing we could do better?
23 Sep 2026 09:41	4	20 Sep 2026	Food or product: Excellent \| Service: Very good \| Cleanliness: Good \| Value for money: Very good		More seats outside on weekends. We waited ten minutes for a table in the sun.

Export to CSV or Excel, or send responses to Google Sheets, Notion, Airtable, Slack or a webhook. All free.

What happens after someone submits

Hear about a bad visit the same day, and see the pattern every week.

Submitted
Feedback arrives

AI triage marks how the customer feels and how urgent it is.
An unhappy customer wants a reply

Reply from their response, and their answer comes back into the same thread.
Once a day or once a week

A digest shows how many customers wrote in and which ones need you first.

Set this up when you use the template

What this form asks, and why

One overall rating first, since it is the number you will track, then how a few parts went and one thing to fix. Contact details come last and only for people who ask for a reply, so a quick rating never turns into paperwork.

The last column shows how often real customer feedback forms ask for it.

Question	Why it is there	Real forms
Overall, how satisfied were you? Required	Asked first, so the first screen is one tap. It is the number to track over time, asked on 8 of 21 forms.	8 of 21 forms
When did you visit? (optional)	Optional, and after the rating so nobody starts with a date. It matches feedback to a shift or a delivery; 9 of 21 forms ask for it.	9 of 21 forms
How did we do on…	One five-point scale for every row. The real forms each use their own; one shelter writes a new scale per row.	8 of 21 forms
Sorry to hear that. What went wrong? Only when “Overall, how satisfied were you?” is 2 or less	Only after a one- or two-star rating, instead of the “do better” question.	16 of 21 forms
What’s one thing we could do better? Only when “Overall, how satisfied were you?” is 3 or more	Asks for one thing to fix, where 16 of 21 forms offer a bare “Comments” box.	4 of 21 forms
Who served you? (optional)	Free text, so praise reaches the right person without a staff leaderboard.	5 of 21 forms
Quote Only when “Overall, how satisfied were you?” is 4 or more	Shown to four- and five-star customers, unchecked. Only Libraries NI asks this.	1 of 21 forms
Would you like us to get back to you?	Keeps contact questions away from everyone who only wants to rate. 5 of 21 forms ask it.	5 of 21 forms
Your name Required Only when “Would you like us to get back to you?” is Yes	Asked only of people who want a reply, where 20 of 21 forms ask everyone.	20 of 21 forms
Email Required Only when “Would you like us to get back to you?” is Yes	Needed for the reply, hidden otherwise.	15 of 21 forms
Phone (optional) Only when “Would you like us to get back to you?” is Yes	Optional, for people who would rather be called. 18 of 21 forms ask for a number.	18 of 21 forms

What we left out

Name, address and phone for everyone. 9 of 21 forms ask for a postal address, and Frisco requires eight identity fields while the feedback itself is optional.
“Email me a copy of this form”. On 13 of 21 forms, all city forms on one platform: a platform default, not a choice anyone made.
A “would you recommend us?” score. None of the 21 forms asks it. If you already track NPS, add the NPS question.

What 21 real customer feedback forms ask

How many include each field, from forms organizations use today. Part of the Form Field Index.

Name 20 of 21
Any phone or mobile number 18 of 21
Open comments box 16 of 21
Email address 15 of 21
“Email me a copy” checkbox 13 of 21
Date of the visit or service 9 of 21
Postal address 9 of 21
Overall rating 8 of 21

Read September 2026 · US 17, UK 2, Canada 1, Türkiye 1 · Sources

National Cyber Security Centre (CHECK scheme) · government agency, UK
Libraries NI · public library service, UK
Quality Inn Conference Centre & Comfort Suites Kingston Central · hotel, Canada
USB Certification · certification and inspection body, Türkiye
City of Frisco, Texas · city government, US
City of Sugar Land, Texas (Sugar Land Regional Airport) · municipal airport, US
City of Grapevine, Texas (IT department) · city government department, US
City of Ankeny, Iowa (Fire Department) · city fire department, US
City of Coppell, Texas (Cozby Library and Community Commons) · public library, US
City of Burleson, Texas (Animal Services) · municipal animal shelter, US
City of San Marcos, Texas · city government, US
City of New Braunfels, Texas (Police Department) · city police department, US
Town of Flower Mound, Texas (Fire Department) · town fire department, US
City of Urbandale, Iowa (Fire Department) · city fire department, US
SourcePak · packaging manufacturer, US
City and County of Broomfield, Colorado (Motor Vehicle) · county motor vehicle office, US
City of Grand Junction, Colorado (Parks & Recreation) · city parks and recreation department, US
Town of Parker, Colorado (Town Clerk's Office) · town government department, US
City of Carmel, Indiana (Fire Department) · city fire department, US
City of Westfield, Indiana (Police Department) · city police department, US
City of Kerrville, Texas (Fire Marshal's Office) · city fire marshal's office, US

How the form changes as people answer

Most people see a shorter form. These questions and screens only appear when an answer calls for them.

When “Overall, how satisfied were you?” is 2 or less

shows “Sorry to hear that. What went wrong?”
When “Overall, how satisfied were you?” is 3 or more

shows “What’s one thing we could do better?”
When “Overall, how satisfied were you?” is 4 or more

shows “Quote”
When “Would you like us to get back to you?” is Yes

shows “Your name”, “Email”, “Phone (optional)” and “We use these details only to reply about your feedback”
When “Overall, how satisfied were you?” is 2 or less

shows the “Sorry we let you down” ending

Make it yours

One QR code per table or branch

Add ?location=Table 4 or ?location=Downtown to the link behind each QR code. The hidden location field saves it with every response.
Pick your version

Choose “After a service or job” or “After a purchase” above the preview: the rated rows, the date and the link’s reference change.
See ratings as they arrive

Slack posts every response to a channel the team watches. On Pro, Email me can put the rating in the subject line.

Good practice and the law

US
Do not ask for reviews only from customers you think will leave positive ones. FTC, soliciting and paying for online reviews
Australia
Say why you collect contact details when you collect them: the privacy line appears with the contact questions. OAIC, APP 5

Questions about this template

Which kind of feedback form do I need?

After a visit, this comment card; after a job, After a service or job; after an order, After a purchase. For an event, the event feedback form rates each part, and for staff, the anonymous suggestion box keeps no IP address.

Can I send happy customers to leave a Google review?

Invite everyone or no one, so the form has no review button for high scores. Put your review link in the receipt every customer gets.

Can customers give feedback without leaving their name?

Yes: contact questions appear only for people who ask for a reply. It is not anonymous, though: it keeps a one-way hash of the IP address and browser details.

Is a comment card the same as a customer feedback form?

Yes, on paper. Print the PDF from this page for the counter and use the link or a QR code for everyone else; both ask the same questions.

Which form do you need?

Not quite the job? One of these may fit, or browse all contact and feedback forms.

anonymous employee feedback form
When people must not be identifiable, such as staff giving feedback about their own workplace.
customer testimonial form
When you want a quote to publish, with a display name and permission.
post-event survey
When people rate an event they came to, part by part, rather than a visit, job or purchase.

Start with the customer feedback form template

Open it in the editor, rename the rated rows and print a QR code for each table or branch.