Customer Churn, Cancellation & Win-Back Survey Template

Get cancellation feedback, uncover missing value, and test win-back offers. Churn exit survey template to collect insights and reduce churn.

What's Included

AI-Powered Questions

Intelligent follow-up questions based on responses

Automated Analysis

Real-time sentiment and insight detection

Smart Distribution

Target the right audience automatically

Detailed Reports

Comprehensive insights and recommendations

Template Overview

Questions

AI-Powered

Smart Analysis

Ready-to-Use

Launch in Minutes

This professionally designed survey template helps you gather valuable insights with intelligent question flow and automated analysis.

Sample Survey Items

Opinion Scale

Before canceling, how often did you use the product?

Range: 1 – 10

Min: RarelyMid: About weeklyMax: Daily

Dropdown

How long had you used the product before canceling?

Less than 1 month
1 to 3 months
4 to 6 months
7 to 12 months
More than 1 year

Multiple Choice

What was the single biggest reason you canceled?

Price was too high
Did not get enough value
Missing critical features
Bugs or reliability issues
Switched to a competitor
Customer support problems
Hard to use
Temporary or short-term need ended
Budget or funding cuts
Onboarding or setup was difficult
Data, privacy, or security concerns

Numeric

Approximately what monthly price (in your currency) would make you reconsider returning?

Accepts a numeric value

Whole numbers only

Short Text

If you switched, which provider did you move to (if any)?

Max 100 chars

Long Text

Please share any details that best describe what led to canceling.

Max 600 chars

Multiple Choice

Were any of the following also factors? Select all that apply.

Price was too high
Did not get enough value
Missing critical features
Bugs or reliability issues
Switched to a competitor
Customer support problems
Hard to use
Temporary or short-term need ended
Budget or funding cuts
Onboarding or setup was difficult
Data, privacy, or security concerns

Long Text

What value did you expect but did not experience with us? Please be as specific as you can.

Max 600 chars

Opinion Scale

Overall, how well did the product fit your needs?

Range: 1 – 10

Min: PoorlyMid: AdequatelyMax: Perfectly

Q10

Multiple Choice

Attention check: To confirm you are reading carefully, please select "I am paying attention."

I am paying attention
I am not paying attention

Q11

Multiple Choice

What would most increase your likelihood of returning? Select up to three.

Lower price or a more affordable plan
Add the specific feature(s) I need
Improve reliability or performance
Better onboarding and guidance
Easier integrations with my tools
More responsive, higher-quality support
Month-to-month or more flexible billing
Longer free trial or return discount
Stronger data privacy and security assurances
Nothing would bring me back

Q12

Rating

How likely are you to try us again in the next 6 months?

Scale: 11 (star)

Min: Not at all likelyMax: Extremely likely

Q13

Dropdown

Which best describes your role?

Individual contributor
Team lead or Manager
Director
Executive
Founder or Owner
Consultant or Freelancer
Student
Other

Q14

Dropdown

About how many employees are in your organization?

Just me
2 to 10
11 to 50
51 to 200
201 to 1,000
1,001 to 5,000
More than 5,000

Q15

Dropdown

What industry do you primarily work in?

Technology
Education
Healthcare
Finance
Retail or eCommerce
Media or Entertainment
Professional Services
Nonprofit
Government
Other

Q16

Short Text

What country or region are you in?

Max 100 chars

Q17

Chat Message

Welcome! This short survey should take about 5 minutes. Please answer based on your most recent experience canceling.

Q18

Long Text

Any other feedback or suggestions you would like to share?

Max 600 chars

Q19

AI Interview

AI Interview: 2 Follow-up Questions on Your Cancellation Experience

AI InterviewLength: 2Personality: [Object Object]Mode: Fast

Q20

Chat Message

Thanks for your time and insights—we appreciate your feedback!

Frequently Asked Questions

What is QuestionPunk?

QuestionPunk is a lightweight survey platform for live AI interviews you control. It's fast, flexible, and scalable—adapting every question in real time, moderating responses across languages, letting you steer prompts, models, and flows, and even generating surveys from a simple prompt. Get interview-grade insight with survey-level speed across qual and quant.

How do I create my first survey?

Sign up, then decide how you want to build: let the AI generate a survey from your prompt, pick a template, or start from scratch. Choose question types, set logic, and preview before sharing.

How can I share surveys with my team?

Send a project link so teammates can view and collaborate instantly.

Can the AI generate a survey from a prompt?

Yes. Provide a prompt and QuestionPunk drafts a survey you can tweak before sending.

How long does support typically take to reply?

We reply within 24 hours—often much sooner. Include key details in your message to help us assist you faster.

Can I export survey results?

Absolutely. Export results as CSV straight from the results page for quick data work.

Churn