User Experience Feedback Accuracy Survey
Help us evaluate the accuracy and quality of user feedback on our product or service.
Your Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Which product or service are you providing feedback on?
*
Please Select
Website
Mobile App
Customer Support
Other
How confident are you in the accuracy of your feedback?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Please rate the following aspects of your feedback experience:
*
Rows
Very Poor
Poor
Average
Good
Excellent
Clarity of feedback instructions
1
2
3
4
5
Ease of providing feedback
6
7
8
9
10
Relevance of feedback questions
11
12
13
14
15
Ability to express opinions
16
17
18
19
20
Perceived usefulness of feedback process
21
22
23
24
25
Did you find the feedback form easy to understand?
*
Yes
Somewhat
No
How likely are you to recommend our feedback process to others?
*
1
2
3
4
5
What motivated you to provide feedback today?
*
Desire to improve the product/service
Positive experience
Negative experience
Incentive or reward
Other
Please provide an example of feedback you have given.
*
In your opinion, how could the feedback process be improved?
Would you like to be contacted for follow-up regarding your feedback?
*
Yes, please contact me
No, I do not wish to be contacted
Submit Feedback
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