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Customer Churn Feedback Survey
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With Event Horizon Theme
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"Customer Churn Feedback Survey"

Streamline Your Website with This Simple Form Addition!
Customer Churn Feedback Survey Form Template

Customer Churn Feedback Survey is your key to unlocking valuable insights on customer departures and enhancing retention strategies. Discover what attracted customers, gauge their satisfaction levels, and gather feedback on issue resolution and retention strategies. Implement this form to transform your business strategy and reduce churn effectively. Pair it with the Event Horizon theme for a striking design that exudes sophistication and power. The dark background, red accents, and borderless inputs create an engaging environment for users to provide feedback and suggestions. Elevate your form-building experience with Wizara's Customer Churn Feedback Survey and Event Horizon theme today!

Get Started Using This Form Template

Customer Churn Feedback Survey Features

Boost Customer Retention
Boost Customer Retention
Understand why customers leave, improve retention, and enhance satisfaction with targeted feedback.
Engage Departing Customers
Engage Departing Customers
Open a dialogue with departing customers to gather valuable insights for business strategy enhancements.
Dark, Bold Design
Dark, Bold Design
Command attention with a striking red and black theme, creating a captivating user experience.
Seamless Borderless Inputs
Seamless Borderless Inputs
Enhance form aesthetics with borderless design for a modern and engaging user interaction.
Easy Readability
Easy Readability
Ensure clarity and effortless navigation with white Open Sans text against a cosmic background.
Transform Business Strategy
Transform Business Strategy
Turn departing customers into loyal ones by implementing direct feedback for lasting improvements.
Customer Churn Feedback Survey Form Template
Customizable Form Fields
You can add, remove or re-arrange form fields when using our form builder app.
htmlHeading (html-block)
Customer Loss Survey
nameFirst* (text, input)
First Name
nameLast (text, input)
Last Name
email* (email)
Email
buttons* (select, radio)
What attracted you to become one of our customers?
rating* (range, buttons)
On a scale of 1-5, how satisfied were you with our products/services before you stopped using them?
feedback1 (text, textarea)
Did you attempt to resolve any problems or issues you experienced before stopping your use of our products/services? If so, how were they addressed?
feedback2 (text, textarea)
Is there anything that our company could have done to prevent you from stopping your use of our products/services?

Try Out the Form for Yourself!

Experience Ease and Flexibility Across Multiple Devices and Screens

The form below is using our "Event Horizon" form theme. You can change the colors and the theme using the Wizara Form Builder app.