Customer Churn Survey Template

1. How long have you been a customer with us?

The answer should be a single choice:

1. Less than 6 months
2. 6 months to 1 year
3. 1 to 2 years
4. More than 2 years

2. Which of the following best describes your current customer status?

The answer should be a single choice:

1. Active
2. Inactive
3. Cancelled

3. What is your age?

The answer should be a single choice:

1. 18-24
2. 25-34
3. 35-44
4. 45-54
5. 55 or older

4. What was the primary reason for you to cancel or become inactive?

The answer should be a single choice:

1. Poor customer service
2. Lack of use
3. Availability of alternative products
4. Cost

5. On a scale of 1 to 10, how likely are you to recommend us to a friend or colleague?

The answer should be a single choice:

1. 1
2. 2
3. 3
4. 4
5. 5
6. 6
7. 7
8. 8
9. 9
10. 10

6. Was there a specific issue or concern that led to your decision to cancel or become inactive? (Optional)

The answer should be a multi line text input.

7. What could we have done differently to retain you as a customer? (Optional)

The answer should be a multi line text input.