Retail Product Satisfaction Assessment Form
Please provide your feedback to help us improve our retail products and services.
Product Name or Description
*
Product Category
*
Please Select
Electronics
Apparel
Home & Kitchen
Beauty & Personal Care
Sports & Outdoors
Toys & Games
Other
Date of Purchase
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Where did you purchase this product?
*
Please Select
In-store
Online
Third-party retailer
Other
Overall, how satisfied are you with this product?
*
1
2
3
4
5
Please rate the following aspects of the product:
*
Rows
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Product Quality
1
2
3
4
5
Value for Money
6
7
8
9
10
Ease of Use
11
12
13
14
15
Packaging
16
17
18
19
20
Customer Service
21
22
23
24
25
Would you recommend this product to others?
*
Definitely
Probably
Not Sure
Probably Not
Definitely Not
What did you like most about the product?
How can we improve this product?
May we contact you for further feedback?
*
Yes, you may contact me.
No, please do not contact me.
Your Email Address (if you wish to be contacted)
example@example.com
Submit Feedback
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