Video Rental Store Customer Feedback Survey Form
Please complete the Video Rental Store Customer Feedback Survey Form to help us improve your experience. Your feedback is valuable and will remain confidential.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Date of Visit or Rental
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What was the main purpose of your visit or rental today?
*
Rent a new release
Return a movie
Browse for movies
Ask for recommendations
Purchase snacks or merchandise
Other
Overall, how satisfied were you with your experience?
*
1
2
3
4
5
Please rate the following aspects of our service:
*
Rows
Excellent
Good
Average
Poor
Not Applicable
Store cleanliness
1
2
3
4
5
Staff helpfulness
6
7
8
9
10
Movie selection
11
12
13
14
15
Checkout process
16
17
18
19
20
Return process
21
22
23
24
25
How would you rate the staff's helpfulness?
*
1
2
3
4
5
How satisfied were you with the movie selection available?
*
1
2
3
4
5
How likely are you to recommend our video rental store to others?
*
Not at all likely
0
1
2
3
4
5
6
7
8
9
Extremely likely
10
0 is Not at all likely, 10 is Extremely likely
Please share any additional comments or suggestions:
Submit Feedback
Should be Empty: