Point of Sale Customer Feedback Survey
Share your feedback about your recent in-store experience to help us improve our service.
Date of your visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
How satisfied were you with your overall experience?
*
1
2
3
4
5
Please rate the following aspects of your visit:
*
Rows
Excellent
Good
Average
Poor
Product selection
1
2
3
4
Staff friendliness
5
6
7
8
Store cleanliness
9
10
11
12
Checkout speed
13
14
15
16
How likely are you to recommend our store to others?
*
Not at all likely
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not at all likely, 10 is Extremely likely
Which best describes your reason for visiting today?
*
Purchase a specific product
Browsing only
Returning an item
Other
Did you find everything you were looking for?
*
Yes, everything
No, some items were missing
No, many items were missing
Were you satisfied with the assistance provided by our staff?
*
Yes, very satisfied
Somewhat satisfied
Not satisfied
Did not interact with staff
What could we do to improve your experience?
Your age group (optional)
Please Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
Prefer not to say
If you would like us to follow up, please provide your email address (optional)
example@example.com
Submit Feedback
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