Customer Shopping Feedback Survey Form
Please share your feedback about your recent store visit and shopping experience.
Date of your visit
*
-
Month
-
Day
Year
Date
Store location visited
*
What was the main reason for your visit?
*
To purchase a specific item
Browsing
Returns or exchanges
Seeking advice or help
Other
How would you rate your overall shopping experience?
*
1
2
3
4
5
Please rate the following aspects of your visit
*
Rows
Very Poor
Poor
Average
Good
Excellent
Staff helpfulness
1
2
3
4
5
Product selection
6
7
8
9
10
Store cleanliness
11
12
13
14
15
Checkout process
16
17
18
19
20
Did you find everything you were looking for?
*
Yes
No
Were there any issues during your visit?
*
No issues
Yes, minor issues
Yes, major issues
How likely are you to recommend our store to others?
*
Not likely
1
2
3
4
5
6
7
8
9
Very likely
10
1 is Not likely, 10 is Very likely
What did you like most about your shopping experience?
Please provide any additional comments or suggestions
Submit Feedback
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