Customer Negative Feedback Handling Survey
Help us improve by sharing your negative experience and how we can address it.
Your Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Which product or service does your feedback relate to?
*
Please Select
Product A
Product B
Product C
Service X
Service Y
Other
How would you rate your overall experience?
*
1
2
3
4
5
What type of issue did you experience?
*
Product Quality
Service Experience
Delivery/Timeliness
Staff Behavior
Communication
Other
Please provide details about your negative experience.
*
How did you try to resolve the issue before contacting us?
*
Contacted Customer Support
Visited Store/Branch
No action taken yet
Other
Please indicate your level of satisfaction with our response (if applicable).
Very Dissatisfied
1
2
3
4
Very Satisfied
5
1 is Very Dissatisfied, 5 is Very Satisfied
What can we do to improve your experience?
May we contact you for follow-up regarding your feedback?
*
Yes, you may contact me.
No, please do not contact me.
Submit Feedback
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