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Customer Experience

Free Churn & Cancellation Survey template

Learn the real reason customers cancel – and what would have kept them.

6 questions · 1 page · about 2 minutes to answer · fully editable after you start

The cancellation moment is one of the few times a churning customer will tell you why, and asking costs nothing. This survey asks the reason for leaving with the honest option set – price, missing features, switched provider, no longer needed – then the one question most teams forget: what would have changed your mind?

Keep it to these six questions, the last (an email address) asked only of those who say you may contact them; a leaving customer owes you nothing. The ranking question on what mattered most turns a pile of anecdotes into a prioritised fix list for your retention roadmap.

Template preview

This is a picture of every question as a respondent would see it, so nothing on it can be clicked or typed into. Use this template to get your own editable copy.

Opens in the Light theme, or in your own default theme if you have set one — change it anytime to any of the 4 built-in looks, or build your own on a paid plan.

Page 1

Before you go

We are sorry to see you go. This survey asks why you are cancelling, so we can understand what we could have done better. It takes about 2 minutes.

Q1.What is the main reason you are cancelling?*

  • Too expensive
  • Missing features I need
  • Switched to another provider
  • Too difficult to use
  • No longer need it
  • Other…

Q2.What could we have done to keep you?

Respondent types their answer here…

Q3.Rank what matters most when you choose a product like ours.

  1. 1Price
  2. 2Features
  3. 3Ease of use
  4. 4Support quality

Q4.How likely are you to consider us again in the future?

012345678910
Not at all likelyExtremely likely

Q5.May we contact you about your feedback?

  • Yes
  • No

Q6.What email address should we use?

Asked only if the answer to Q5 is “Yes”.

Respondent types an email address here (checked before they go on)…

Where this template is used

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