Q01
Message
All templates
Customer Churn & Win-Back Exit Interview
Understand why a customer actually left, what nearly kept them, and what could bring them back — combining structured ratings on price, product, and support with an AI voice follow-up that reconstructs the real trigger behind the decision instead of the generic reason picked from a list. Built for CS, retention, and product teams running win-back research.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
12 questions · ~12 min
Q02
Multiple ChoiceRequired
Which of the following best describes your primary reason for discontinuing service?
- Price / cost
- Switched to a competitor (Replace with Competitor A/B; Template note: list your real competitors before launching)
- Product or service didn't meet my needs
- Poor customer support experience
- No longer need this type of product or service
- Change within my company or team (e.g., new decision-maker, budget cuts)
- Other
Q03
MatrixRequired
Thinking back to your time as a customer, how satisfied were you with each of the following?
5 rows × 5 columns
- Overall value for the price
- Product or service quality
- Customer support responsiveness
- Ease of use
- Onboarding experience
Columns: Very dissatisfied · Dissatisfied · Neutral · Satisfied · Very satisfied
Q04
Best–Worst Trade-off (MaxDiff)Required
Which of these, if we had offered them before you decided to leave, would have most and least influenced you to stay?
- Lower price or a better discount
- Faster response from support
- More product features
- Better onboarding or training
- More proactive communication from our team
- An easier way to pause instead of cancel
- A dedicated account manager
- Improved product reliability
Pick best & worst per setBest:Would have most influenced me to stayWorst:Would have least influenced me to stay
Q05
Opinion ScaleRequired
In the weeks before you decided to leave, how likely were you to recommend us to a friend or colleague?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q06
Multiple Choice
Have you already switched to another provider or workaround for this need?
- Yes, a direct competitor (Replace with Competitor A)
- Yes, a different type of solution or a manual workaround
- No, not yet
- No, I no longer need this
Q07
Opinion ScaleRequired
If your main concerns were addressed, how likely would you be to consider us again in the future?
Scale: 1 – 7
Min:Not at all likelyMax:Extremely likely
Q08
Voice AI Interview
Exit interview: the real story behind the decision
Uncover the specific trigger event that led this customer to cancel — not just the category they picked, but the moment or accumulation of moments that tipped the decision. If they cite price, probe whether price alone w…
Q09
Long Text
Is there anything else about your experience you'd like us to know?
Q10
Multiple Choice
How long were you a customer with us?
- Less than 3 months
- 3-12 months
- 1-3 years
- More than 3 years
- Prefer not to say
Q11
Multiple Choice
Which best describes your role in the decision to leave?
- Sole decision-maker
- Part of a team decision
- I influenced but didn't decide
- Prefer not to say
Q12
Message
Thank you for your candor — it genuinely helps. Your responses go straight to the team responsible for the issues you raised, and where you agreed to be contacted, someone may follow up personally.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Combines structured ratings (satisfaction matrix on price, product, and support) with max-diff prioritization of what could have kept the customer, so you get both quantifiable signal and priority ranking, not just a single 'reason' dropdown
- Includes an AI voice follow-up interview that probes past the generic multiple-choice reason to reconstruct the actual trigger behind the decision, plus a chance to gauge willingness to return if concerns were addressed
- Every response is automatically quality-scored and summarized into a report, so CS and retention teams don't have to manually read through open-ended answers to find the real story
- Transparent prompts mean you can see exactly what the AI asked and why, which matters when these interviews inform retention strategy or get shared with leadership
Jotform
Customer Loss Survey Evaluation Form TemplateA static, drag-and-drop customizable exit survey form template within Jotform's large form library. It's fielding-ready but relies on fixed questions rather than any adaptive follow-up. Good for teams that just need a quick, editable form rather than deeper qualitative reconstruction of the churn decision.
What it does well
- Easy visual customization via Jotform's drag-and-drop builder
- Part of a broad, established template library with wide integration options
- Simple to deploy quickly for basic exit data collection
Where it falls short
- No adaptive AI follow-up questioning — every respondent sees the same fixed question set
- No voice interview option to capture nuance behind a churn reason
- No automated per-response quality scoring or transparent AI prompt methodology
QuestionPro
Customer Loss Survey + Sample Questionnaire TemplateA sample questionnaire template from a full-featured research/CX survey platform. It's a static template page meant as a starting questionnaire rather than a fielding-ready adaptive interview. Useful if you want a broad CX platform with many survey types beyond exit research.
What it does well
- Backed by a research-oriented survey platform with broader CX and market research tooling
- Sample questionnaire gives a concrete starting point for question wording
- Likely supports standard logic/branching common to enterprise survey tools
Where it falls short
- No adaptive AI interview that follows up based on a respondent's actual answer
- No voice AI option to capture the real trigger behind a decision
- No published transparent prompt methodology or automated quality scoring per response
SurveySparrow
Customer Exit Survey TemplateA conversational-style exit survey template — one question at a time in a chat-like interface — which reads more naturally than a traditional form. However, it's still a fixed question sequence rather than a true adaptive interview that changes based on what the customer says. Reasonable fit for teams wanting a friendlier UX without deeper probing.
What it does well
- Conversational, chat-like question flow that can feel less like a form
- Purpose-built exit survey template, not a generic form repurposed
- Likely supports basic skip logic based on earlier answers
Where it falls short
- Conversational tone is scripted, not adaptive — no AI reconstructing the real reason from open dialogue
- No voice interview capability
- No automated quality scoring or transparent AI prompt disclosure
Typeform
Customer Loss Survey TemplateA one-question-at-a-time template using Typeform's signature conversational UI. It's fielding-ready and pleasant to fill out, but the question logic is still author-defined and static rather than generated dynamically from the respondent's prior answers. Best suited to teams prioritizing a clean respondent experience over deep qualitative probing.
What it does well
- Polished, well-known conversational UI that tends to improve completion rates
- Fielding-ready template with standard logic/branching
- Easy to customize visually and embed
Where it falls short
- No AI-driven adaptive follow-up — logic branches are pre-set by the template author, not generated from the answer's content
- No voice AI interview to reconstruct the real churn trigger
- No automated per-response quality scoring or transparent prompt methodology
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.