Customer Experience Decision Making Form
Please complete this form to report a customer experience issue, assess its impact, and help us route it for prompt resolution.
Your Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Issue Category
*
Please Select
Product Quality
Service Experience
Billing/Payment
Technical Support
Delivery/Shipping
Other
Describe the Issue
*
How severe is the impact on the customer?
*
No Impact
1
2
3
4
Critical Impact
5
1 is No Impact, 5 is Critical Impact
How urgent is this issue?
*
Immediate attention needed
Within 24 hours
Within 3 days
Routine
Customer Satisfaction Rating (before resolution)
*
1
2
3
4
5
Recommended Next Action
*
Escalate to Supervisor
Resolve Immediately
Schedule Follow-up
Request More Information
Route this case to
*
Please Select
Customer Service
Technical Support
Billing Department
Quality Assurance
Other
Additional Comments or Details
Submit
Should be Empty: