Shoe Purchase Feedback Form
Please share your feedback about your recent shoe purchase to help us improve our products and service.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Which shoe did you purchase? (Model/Name)
*
What size did you purchase?
*
Please Select
5
6
7
8
9
10
11
Other (please specify)
Where did you purchase the shoes?
*
Online Store
Physical Store
Third-party Retailer
Other
Purchase Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you rate the following aspects of your new shoes?
*
Rows
Poor
Fair
Good
Very Good
Excellent
Comfort
1
2
3
4
5
Fit
6
7
8
9
10
Style/Appearance
11
12
13
14
15
Durability
16
17
18
19
20
Value for Money
21
22
23
24
25
Overall, how satisfied are you with your purchase?
*
1
2
3
4
5
How likely are you to recommend our shoes to others?
*
Not likely
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not likely, 10 is Extremely likely
What did you like most about your new shoes?
What could we improve?
Submit Feedback
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