Use this when

A job, order, appointment, or support interaction is complete and you want useful customer feedback.

Then

Route urgent issues to a responsible owner and turn positive feedback into a testimonial request when appropriate.

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Customer Feedback & Satisfaction Form

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CUSTOMER FEEDBACK & SATISFACTION FORM
Document version 1.0.0


Created with FreeBusinessForms.com

Prompt for AI

Ask AI for a custom customer feedback.

Copy into ChatGPT, Claude, or another assistant for a fillable version.

You are an experienced customer-operations document designer for small businesses.

Create a customer feedback and satisfaction form used after a job, order, appointment, or support interaction. It should gather a rating, what worked, what to improve, follow-up permission, and whether you may later ask for a testimonial.

Include these sections:
- Business and customer ([Business name], [Customer name], [Customer email], [Related order, job, or invoice], [Feedback date])
- Rating ([Overall rating 1–5 with labels])
- Narrative ([What worked well?], [What could be improved?])
- Permission ([May we follow up?], [May we request testimonial permission?])
- Internal ([Internal owner], [Urgent issue?], [Next action])

Do not include Social Security numbers, full bank or payment-card numbers, routing numbers, passwords, tax ID numbers, medical details, identity documents, or protected-class information. This is an operational template, not legal, tax, accounting, payroll, collections, or employment advice.

Output a clean fillable template I can copy into a document and adapt. Use a professional tone, clearly labeled sections, and [bracketed] placeholders for every fill-in value. Close with a short practical review checklist.

Recommended books

Books for this form

Practical books that pair with this document. Links use our Amazon Associates ID.

The Effortless Experience

Matthew Dixon, Nick Toman, and Rick DeLisi

Treats feedback as a signal about effort, not a vanity score.

View The Effortless Experience on Amazon

Hug Your Haters

Jay Baer

Shows why the complaint fields are the most valuable part of the form.

View Hug Your Haters on Amazon

The Power of Moments

Chip Heath and Dan Heath

Helps you turn a strong comment into a specific follow-up, not a generic thank-you.

View The Power of Moments on Amazon

Machine access

JSON Schema

Agents can inspect and validate the same versioned fields. View JSON Schema →

Inspect JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://freebusinessforms.com/schemas/customer-feedback-form.json",
  "title": "Customer Feedback & Satisfaction Form",
  "description": "Gather structured feedback, satisfaction ratings, testimonials, improvement requests, and follow-up permission.",
  "type": "object",
  "additionalProperties": false,
  "properties": {
    "business_name": {
      "title": "Business name",
      "type": "string"
    },
    "customer_name": {
      "title": "Customer name",
      "type": "string"
    },
    "customer_email": {
      "title": "Customer email",
      "type": "string",
      "format": "email"
    },
    "related_order_or_job": {
      "title": "Related order, job, or invoice",
      "type": "string"
    },
    "feedback_date": {
      "title": "Feedback date",
      "type": "string",
      "format": "date"
    },
    "overall_rating": {
      "title": "Overall rating",
      "type": "string",
      "enum": [
        "5 - Excellent",
        "4 - Good",
        "3 - Okay",
        "2 - Poor",
        "1 - Very poor"
      ]
    },
    "what_worked": {
      "title": "What worked well?",
      "type": "string"
    },
    "what_to_improve": {
      "title": "What could be improved?",
      "type": "string"
    },
    "may_contact": {
      "title": "May we follow up?",
      "type": "string",
      "enum": [
        "Yes",
        "No"
      ]
    },
    "testimonial_permission": {
      "title": "May we request testimonial permission?",
      "type": "string",
      "enum": [
        "Yes",
        "No",
        "Ask later"
      ]
    },
    "internal_owner": {
      "title": "Internal owner",
      "type": "string"
    }
  },
  "required": [
    "business_name"
  ],
  "x-form-version": "1.0.0"
}