Cancellation Survey Form Sample

Please help us learn more about why you decided to cancel your account. Your responses will help us improve our product.

Overall, how satisfied were you with your account?

Very Satisfied

Somewhat Satisfied

Neutral

Unsatisfied

Very Unsatisfied

What was the primary reason for canceling your account?

This is only temporary․ I'll be back!

It didn't meet my needs․

Quality was less than expected․

Ease of use was less than expected․

Other:

Would you use our product in the future?

Definitely

Probably

Not Sure

Probably Not

Definitely Not

Would you recommend us to a friend?

Definitely

Probably

Not Sure

Probably Not

Definitely Not

We'd like to hear some suggestions

We're sorry to see you're leaving

Your cancellation request was sent.