Lost-Customer Listening Form Survey Template
Learn the main reason a customer left, what they chose instead, and what was missing.
Version 1. Content review is pending; review the wording before publishing.
4
questions
~2
minutes
0
demo uses
Create a draft from the backend template key, then edit questions, logic, targeting, and reporting in your workspace.
Best for
Customers who stopped using a product.
Decision output
Learn the main reason a customer left, what they chose instead, and what was missing.
Method
Structured survey with optional open-text follow-ups
Before you use this template
- • Follow-up permission is a preference recorded with this response. This form does not send messages or identify an anonymous respondent.
- • Use an existing, permitted customer channel if follow-up is agreed. Do not request personal or sensitive information in open text.
- • Review wording and settings before publishing. Embed collection requires a published survey and an approved parent origin. Preview questions contain no collected responses.
Suggested Expert Roles
UX researcher
Usability, workflow, adoption
Browse matching experts
Research advisor
Survey design, sample plan, readout
Browse matching experts
Conjoint methodologist
Conjoint, pricing, segmentation
Browse matching experts
Initial sample planning range: Set targets for the audience groups and comparisons you need. Confirm them against the method before recruiting.Pair this template with expert review when the study affects pricing, investment, launch, or regulated workflow decisions.
Build an expert invite panel from this templatePreview Sections
Leaving and alternatives
Listen to the decision without a sales pitch.
Question Preview
1. What was the main reason you stopped using {{product_name}}?
2. What are you doing instead?
3. What did you need that we did not provide? (optional)
4. If your customer account already gives us a way to contact you, may we follow up about this feedback?
Template FAQ
Who is the Lost-Customer Listening Form template for?
It is designed for customers who stopped using a product. and teams that need Learn the main reason a customer left, what they chose instead, and what was missing..
How many questions are included?
Lost-Customer Listening Form includes 4 questions across 1 sections and takes about 2 minutes to complete.
Can I customize this template?
Yes. Use the create-draft flow to copy the template into the builder, then adjust wording, targeting, logic, branding, and analytics settings before launch.