QuestionPunkQuestionPunk
Start free
All templates

Form & Checkout Abandonment Diagnostic Survey

Diagnoses why users abandon forms, signups, and checkout flows. Captures the specific step, blockers, and recovery levers to reduce drop-off and improve conversion rates.

Use this templateBrowse more templates

Sample questions

A preview of what’s in the template. Every question is editable before you launch.

18 questions · ~9 min
Q01
Message

Welcome, and thank you for taking a few minutes to share your experience. This short survey (approximately 9 minutes) asks about a recent task you started but did not complete on our platform. Your responses are confidential, reported only in aggregate, and will be used to improve the product experience. Participation is entirely voluntary — there are no right or wrong answers, and you may stop at any time.

Q02
Dropdown

When did you last attempt this flow?

  • In the last 24 hours
  • 2–3 days ago
  • 4–7 days ago
  • 8–14 days ago
  • 15–30 days ago
  • More than 30 days ago
  • I don't remember
Q03
Multiple Choice

What were the main reasons you did not finish? Select all that apply.

  • Too many steps or took too long
  • Confusing navigation or instructions
  • Price or fees felt too high
  • Trust or security concerns
  • Technical issue or error
  • Payment declined or verification failed
  • Missing required info (e.g., ID, document)
  • Slow load times or performance
  • Wanted to compare options or not ready
  • Prefer to do it on another device
Q04
Opinion Scale

How likely are you to try completing this flow again in the next 7 days?

Scale: 1 – 7
Min:Not at all likelyMax:Extremely likely
Q05
Opinion Scale

Overall, how clear were the steps in this flow?

Scale: 1 – 7
Min:Not at all clearMax:Extremely clear
Q06
Dropdown

Which region do you live in?

  • Africa
  • Asia
  • Europe
  • Latin America
  • Middle East
  • North America
  • Oceania
  • Prefer not to say
Q07
Message

Thank you for your time — your feedback directly helps us improve this experience.

Q08
Multiple Choice

Which type of flow did you start but not finish?

  • Create account / sign up
  • Checkout / purchase
  • Upgrade / subscribe
  • Booking / reservation
  • Add payment method
  • Form submission (e.g., application, quote)
  • Onboarding / setup
  • Feature configuration / settings
  • Search / discovery
Q09
Ranking

Rank the following barriers by how much they affected your decision not to complete the flow. Drag the biggest barrier to the top.

  1. Price or fees
  2. Technical bug or error
  3. Too much information required
  4. Confusing steps or layout
  5. Payment friction
  6. Privacy or trust concerns
Drag to rank
Q10
Multiple Choice

What would most help you complete this flow next time? Select up to 3.

  • Shorter or fewer steps
  • Clearer guidance and examples
  • Save progress and resume later
  • Guest checkout or fewer fields
  • More payment options
  • Installments or pay later
  • Live chat or faster support
  • Better error messages
  • Show total cost and fees earlier
Q11
Long Text

Based on your experience, is there anything else we should fix or know about this flow?

Q12
Dropdown

What is your age group?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65+
  • Prefer not to say
Q13
Multiple Choice

Which device or platform were you using?

  • Mobile app
  • Mobile web browser
  • Desktop/laptop web browser
  • Tablet
Q14
AI Interview

We'd like to understand more about what got in the way. An AI interviewer will ask you a couple of follow-up questions about your specific experience.

Q15
Multiple Choice

Would any of the following incentives motivate you to return and complete the flow? Select all that apply.

  • Small discount or coupon
  • Free shipping or waived fees
  • Bonus feature or trial extension
  • Loyalty points or credit
  • None of these
Q16
Multiple Choice

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer not to say
Q17
Multiple Choice

Which step best describes where you left off?

  • Selecting items or options
  • Review / cart / summary
  • Sign in or account creation
  • Payment or billing
  • Identity / verification
  • Address or shipping details
  • Confirmation step
  • I don't remember
Q18
Multiple Choice

If we were to follow up with you, which channel would you prefer?

  • In-app message
  • Email
  • SMS/text
  • Push notification
  • No follow-up

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

  • Pinpoints the exact drop-off step with a dedicated multiple-choice question, then layers a ranking question so respondents prioritize which barriers mattered most — not just which applied.
  • Includes an AI follow-up interview that adaptively probes deeper into whatever blockers a respondent selects, surfacing specifics that fixed-choice questions alone would miss.
  • Goes beyond diagnosis into recovery: dedicated questions on incentives that would motivate a return, preferred follow-up channel, and likelihood to retry within 7 days.
  • Pairs qualitative depth (open-text 'anything else we should fix' question) with quantitative clarity ratings and demographic dropdowns for segment-level analysis, then rolls it all into an auto-generated report.

QuestionPro

Usability Survey For Self-Service Checkouts + Sample Questionnaire Template

This template targets usability of self-service checkout kiosks/machines in a retail setting rather than online form or checkout funnel abandonment specifically, so the fit is partial. It's a static sample questionnaire meant to be customized and fielded, not an adaptive interview. Useful as a general usability feedback starting point, but not built to isolate a specific abandoned step in a multi-page online flow.

What it does well

  • Provides a ready-made sample questionnaire so teams don't start from a blank page
  • Backed by QuestionPro's broader survey distribution and reporting tooling
  • Focuses specifically on checkout usability, a directly related research topic

Where it falls short

  • Fixed set of questions with no adaptive AI follow-up to dig into why a specific respondent struggled
  • No per-response quality scoring or transparent prompt methodology published
  • No option for a voice AI interview to capture richer verbal detail on checkout friction

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.

Use this templateStart free