Customer Feedback Form

This template is designed to be versatile and applicable to various industries, from retail and hospitality to digital services. It focuses on the four pillars of service: Professionalism, Efficiency, Resolution, and Personalization.

General Information

Customer Name

Date of Interaction

Interaction Channel

In-Person

Phone

Email/Support Ticket

Live Chat/Social Media

Representative Name (if known)

The Experience

Please rate the following statements on a scale of 1 to 5. (1 = Strongly Disagree, 5 = Strongly Agree)

1

2

3

4

5

The representative was friendly and polite.

The representative listened to my needs without interruption.

My inquiry was handled in a timely manner.

The representative was knowledgeable about the product/service.

The representative communicated clearly and effectively.

Problem Resolution

Was your issue resolved during this interaction?

Yes, completely.

Partially (Follow-up required).

No, it remains unresolved.

How much effort did you personally have to put forth to handle your request?

Very Low Effort

Moderate Effort

High Effort

Overall Satisfaction & Loyalty

Overall, how satisfied are you with the service you received?

Very Dissatisfied

Dissatisfied

Neutral

Satisfied

Very Satisfied

Based on this experience, how likely are you to recommend us to others? (0 = Not at all likely, 10 = Extremely likely)

Qualitative Feedback

What did the representative do particularly well? (e.g., empathy, technical skill, speed)

What is one thing we could have done differently to improve your experience?

Any additional comments or shout-outs?

Form Template Insights

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Detailed Insights on the Customer Feedback Form Template

To provide a deeper understanding of why this template works, we must look at the mechanics of customer feedback.

1. The Structure of Perception

The form is organized to move from objective facts to subjective feelings. By asking for the "Interaction Channel" and "Date" first, you anchor the customer’s memory to a specific event before asking them to evaluate performance. This reduces the risk of "generalized venting" and keeps the feedback focused on a single moment in time.

2. Key Performance Indicators (KPIs)

Each section of the form targets a specific metric used by top-tier service organizations:

  • CSAT (Customer Satisfaction Score): This is found in the "Overall Satisfaction" question. it is a "here and now" metric that tells you how the customer feels immediately after the interaction.
  • CES (Customer Effort Score): The question regarding "How much effort did you personally have to put forth?" is vital. Modern service trends show that customers value ease over "wow" moments. A low-effort experience is the strongest predictor of repeat business.
  • NPS (Net Promoter Score): The "Likely to recommend" question (0–10 scale) measures long-term loyalty. It categorizes users into Promoters (9-10), Passives (7-8), and Detractors (0-6).

3. Behavioral Insight: The Likert Scale

The use of a 1–5 scale (known as a Likert Scale) is intentional.

  • The Neutral Center: Offering a "3" allows customers who had an unremarkable but acceptable experience to be honest.
  • Symmetry: It provides a balanced way to measure intensity of feeling in both positive and negative directions.

4. Qualitative vs. Quantitative Balance

A template that only uses checkboxes provides numbers without context. A template that only uses text boxes provides context that is too difficult to measure.

  • Quantitative (Ratings): These allow you to create graphs and see trends over months. For example, you might see that "Timeliness" scores drop every Tuesday, indicating a scheduling issue.
  • Qualitative (Comments): These provide the "flavor." They help you understand if a low score in "Knowledge" was due to a specific new product launch or a general training gap.

5. Strategic Benefits of the "Resolution" Question

This is the most critical checkpoint. By separating Resolution from Satisfaction, you can identify "Polite Failures."

Example: A customer might rate the staff member a "5" for friendliness but a "1" for resolution. This tells you that your staff has great people skills, but your internal systems or authorities are preventing them from actually helping the customer.

6. Closing the Feedback Loop

The value of the form isn't just in the collection of data, but in the response to it. When using this template:

  • Identify Trends: Look for patterns across different channels (e.g., is Chat performing better than Phone?).
  • Internal Recognition: Use the "shout-out" section to boost staff morale by sharing positive comments during team meetings.
  • Continuous Improvement: Use the "one thing we could have done differently" section as a direct to-do list for your next service update.


Mandatory Questions Recommendation

Please remove this mandatory questions recommendation before publishing.

Mandatory Fields Analysis

Here are the essential questions and the reasoning behind them:

1. The Resolution Status

Question: "Was your issue resolved during this interaction?"


Why it’s mandatory: This is the ultimate metric for customer support. A representative can be the friendliest person in the world, but if the customer's problem remains unsolved, the service has failed its primary objective.


The Insight: It allows you to calculate your First Contact Resolution (FCR) rate. High FCR is the strongest driver of customer satisfaction and reduces the cost of "callback" volume.

2. Overall Satisfaction (CSAT)

Question: "Overall, how satisfied are you with the service you received?"


Why it’s mandatory: This provides a single, high-level data point that summarizes the user’s emotional state. It is the industry standard for benchmarking.


The Insight: It acts as a "temperature check." If a customer gives high marks for "Friendliness" but a low mark for "Overall Satisfaction," it signals that your processes (like wait times or policies) might be the problem, rather than the staff.

3. Representative Performance (Knowledge/Professionalism)

Question: "The representative was knowledgeable and professional." (Likert Scale)


Why it’s mandatory: You need to distinguish between the person and the product. Sometimes a customer is unhappy because the product broke, but they were impressed by the person who helped them.


The Insight: This is your primary tool for staff coaching. It helps you identify which team members are ambassadors for your brand and which may need more technical training or soft-skills development.

4. Qualitative Feedback (Open-Ended)

Question: "What is one thing we could have done differently?" OR "Additional Comments."


Why it’s mandatory: Data tells you what is happening; comments tell you why. A "3 out of 5" rating is ambiguous, but a comment explaining that "the music on hold was too loud" provides a specific, fixable action.


The Insight: This often reveals "blind spots" that you didn't think to ask about in the multiple-choice section. It gives the customer a voice, which in itself can improve their perception of your brand.


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