Create a customer feedback Google Form
Ask about one recent experience, then separate the satisfaction rating from what caused it. This example combines a labeled 1–5 scale with two open questions and an optional follow-up contact.
Use this example →Who this is for
Teams deciding what to improve after a customer has used a service or product.
Example form
Plain text to adapt
Customer Experience Feedback > Please think about your most recent experience with us. *How satisfied were you? [scale] low=1 high=5 low_label="Very dissatisfied" high_label="Very satisfied" What worked well? [paragraph] What is the one thing we should improve? [paragraph] May we contact you about your feedback? [multiple_choice] - Yes - No Email (optional — only if you would like a reply) [text]
Parsed preview
Customer Experience Feedback
Please think about your most recent experience with us.
- How satisfied were you? [scale] · Required
1 — Very dissatisfied · 5 — Very satisfied
- What worked well? [paragraph]
- What is the one thing we should improve? [paragraph]
- May we contact you about your feedback? [multiple_choice]
- Yes
- No
- Email (optional — only if you would like a reply) [text]
About this example
- Five questions; the same scale anchors should be used across comparable rounds.
- The email field is optional and asks for an address only if the customer would like a reply. It stays visible regardless of the contact-permission answer.
Before you start
- Replace “us” with the service or experience being reviewed and specify the relevant time period.
- Decide who will read feedback, how you will prioritize one change, and when you will revisit it.
- If you do not need follow-up, remove both the contact-permission and email questions.
Create your form
- Open the example and name the specific experience in the title or introduction.
- Review the labeled scale and open questions in Check & Preview. Keep the same scale when comparing future rounds.
- Create the Google Form in your own account, check its settings and respondent view, then share it with the intended customers.
Limits and settings to check
- SurveysAI creates the form; it does not analyze responses or automatically select an improvement. Review answers in Google Forms.
- The form is not automatically anonymous. An optional email and account settings can identify a respondent.
- The contact question does not hide the email field conditionally. State clearly that leaving an email is optional and only requested if follow-up is welcome.