Customer Feedback Form Template

The Customer Feedback Form Template – Canada is offered in multiple formats including PDF, Word, and Google Docs. Each version is both customizable and ready for printing, ensuring that you can easily meet your feedback collection needs.

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Sample

Customer Feedback Form Template – Canada

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1. Customer Information

2. Date of Visit

3. Service/Product Experienced

4. Satisfaction Rating
1 – Very Dissatisfied
2 – Dissatisfied
3 – Neutral
4 – Satisfied
5 – Very Satisfied

5. Feedback

6. Would You Recommend Us?
Yes
No

7. Additional Comments

8. Consent for Follow-Up
I give permission to be contacted for follow-up regarding my feedback.

9. Submission Confirmation

I confirm that the information provided in this form is accurate to the best of my knowledge.

Date:

PDF

WORD

Examples

Customer Feedback Form Template – Canada (1)

Feedback Form Introduction:
We value your feedback! Please take a moment to fill out this form regarding your recent experience with our services.

Customer Information:
Name: ___________________________
Email: ___________________________
Phone: ___________________________

Date of Service:
___________________________

Service Rating:
Please rate our service on a scale from 1 to 5:
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Rating: [ ] [ ] [ ] [ ] [ ]

What did you like about our service?
_____________________________________________________________
_____________________________________________________________

What could we improve?
_____________________________________________________________
_____________________________________________________________

Additional Comments:
_____________________________________________________________
_____________________________________________________________

Would you recommend our services to others?
[ ] Yes [ ] No

Signature:
___________________________
Date: ___________________________

Customer Feedback Form Template – Canada (2)

Introduction:
Your feedback is essential for us to improve. Please complete the following form to help us enhance our services.

Customer Details:
Full Name: ___________________________
Email Address: ___________________________
Contact Number: ___________________________

Service Feedback:
Type of service used:
[ ] Product Purchase [ ] Customer Support [ ] Consultation [ ] Other: ___________
On a scale of 1 to 10, how satisfied were you with our service?
1 (Not Satisfied) – 10 (Very Satisfied)
Rating: [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]

Feedback Content:
What did you appreciate the most about our service?
_____________________________________________________________
_____________________________________________________________

Areas for Improvement:
What suggestions do you have for us?
_____________________________________________________________
_____________________________________________________________

Would you like to be contacted regarding your feedback?
[ ] Yes [ ] No

Please add any other comments:
_____________________________________________________________
_____________________________________________________________

Customer Signature:
___________________________
Date Signed: ___________________________

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Customer Feedback Form Template - Canada