---
title: Customer feedback survey form template, free
description: A free customer feedback survey form template. Rate the experience, say what went well and what did not, and choose whether to be contacted. Publish it as one link; every response is its own signed copy.
---

# Customer feedback survey

Rate the experience, say what went well and what did not, and choose whether to be contacted.

Hear from customers in their own words, with ratings you can compare.

## About you

- Name (text)
- Email (email)

## Your experience

- Date (text, optional)
- Overall satisfaction (choice)
- Likely to recommend (choice)
- What went well (text, optional)
- What could be better (text, optional)
- Parts used (choose any, optional)

## Permissions

- You may contact me about my feedback. (tick box, optional)
- You may quote my comments, without my name, in your own materials. (tick box, optional)

## Signature

- Customer signature (signature)
- Customer date signed (date signed)