Termination of service questionnaire template

Dear Sir / Madam,

thank you for visiting us. By filling out this 5-10 minute survey, you will help us obtain the very best results.

1. What is your gender?

  • Male
  • Female

2. Which category includes your age?

  • 18 - 24
  • 25 - 34
  • 35 - 44
  • 45 - 54
  • 55 - 64
  • 65 or above

3. How long have you been using our service?

  • Less than 1 month
  • 1-6 months
  • 6-12 months
  • Over 1 year

4. How often did you use our service?

  • Once per week
  • Once per month
  • Once per year

5. How did our service compare to similar services from other companies?

  • Much better
  • Better
  • About the same
  • Worse
  • Don’t know

6. How satisfied were you with our service?

  • Very satisfied
  • Satisfied
  • Neither satisfied nor dissatisfied
  • Dissatisfied
  • Very dissatisfied

7. What was your primary reason for discontinuing our service?

  • No longer needed the service
  • Found another service
  • Quality of the service
  • Ease of use of the service
  • Access to the service

8. Would you use our service in the future, if you have had a need for it?

  • Definitely
  • Probably
  • Not sure
  • Probably not
  • Definitely not

9. What could we do to improve our service?


Use template — it’s free

Service Cancellation Survey

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Don’t lose clients. Prevent them from leaving. If they insist on a change, give them a termination of service questionnaire template and determine the cause.

Use template — it’s free

The survey sample is ideal for

  • entities in the commercial sector.

Are your clients leaving and you don't know why? The only solution in this situation is to ask them. What are the main reasons for dissatisfaction that lead to these decisions? Can they be directly identified and is it possible to prevent further customer outflows? Use a survey with pre-prepared questions, which you can adjust as needed. With regular and long-term surveys, you can track how each customer behaves and, according to the first signs leading to change, intervene in a timely and adequate manner.

The questionnaire template can be fully edited. Survio will process your answers into well-arranged tables and graphs.

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