Collect feedback about products, delivery, communication, and service with this free customer satisfaction survey template for Word. The document combines six five-point rating questions with four open-ended prompts, giving customers space to explain their experience.
Adapt the questions to your business before distributing the form. The original includes placeholder introductory text and contact-information fields, so it is not ready to issue unchanged.
Download the Customer Satisfaction Survey
Format: Microsoft Word (.docx). Included: a five-point response key, six rating questions, four comment prompts, and contact fields in the document.
Download Customer Satisfaction Survey for Word
Before use: replace the Lorem ipsum paragraph, review the question wording, and explain how completed forms should be returned. The file does not collect responses online or calculate scores.
Survey Form Preview

The original scale uses 1 for Very Satisfied and 5 for Very Dissatisfied. Keep the direction clear in both the form and any results summary.
What Does the Original Survey Ask?
The six rating items cover product delivery, product quality, sales-representative response time, customer communications, custom-product quality, and overall customer-service satisfaction.
The open-ended prompts ask what customers like, what they dislike, how the business could serve them better, and whether they have further comments. These responses can add context that a rating alone does not provide.
Remove questions that do not apply. For example, a business without custom products should replace that item rather than asking customers to rate something they have not experienced.
Understand the Five-Point Scale
| Original score | Meaning |
|---|---|
| 1 | Very Satisfied |
| 2 | Somewhat Satisfied |
| 3 | Neutral |
| 4 | Somewhat Dissatisfied |
| 5 | Very Dissatisfied |
Lower scores indicate greater satisfaction in this file. If you reverse the direction, update every label and your reporting method. Do not combine responses from differently coded versions without aligning the coding.
Add “Not applicable / Not experienced” where customers may not have used a service. Treat it separately from Neutral and exclude it from any calculation that requires a valid satisfaction rating.
How to Customize the Survey in Word
- Save a working copy. Identify the business, survey purpose, and version or collection period.
- Replace the introduction. Explain the experience being reviewed, how to mark answers, and how to return the form.
- Choose a clear reference. Ask about a specified visit, order, interaction, or period rather than leaving customers to guess.
- Align question wording with the scale. Change “How do you rate…” questions to satisfaction wording when using satisfaction response labels.
- Keep one topic per item. Separate issues you need to understand independently.
- Review contact fields. Keep only those you need and distinguish optional follow-up details from the feedback itself.
- Test the form. Ask a few people to check clarity, response marking, and completion time before broader use.
Sample Introduction and Questions
Adapt this introduction to the actual process:
Please tell us about your experience with [Order / Visit / Service] on [Date / Period]. Select one response for each rating question, or choose Not applicable if you did not experience that service. You may also add comments. Please return the form using [Method]. [Explain whether contact details are optional and how responses will be used.] Thank you for your feedback.
Possible rating questions include:
- How satisfied are you with the delivery of your order?
- How satisfied are you with the quality of the product you received?
- How satisfied are you with the time taken to respond to your inquiry?
- How satisfied are you with the clarity of our communications?
- Overall, how satisfied are you with this customer-service interaction?
For an optional comment prompt, ask “What is one thing we could improve?” Keep a broader comments area if customers may want to raise something your questions do not cover.
Be Clear About Contact Details and Anonymity
The Word file includes Name, Phone Number, Fax Number, Company, and Email Address fields. These are not visible in the preview above, so review the whole document before distributing it.
Do not call the survey anonymous merely because customers can leave a name blank. Consider the collection method and any identifying order references. If follow-up is optional, say so and use a separate, clearly labeled contact section. Promise only the confidentiality arrangements your process actually provides.
How to Summarize the Responses
Record the survey version, response period, valid answers, and missing or not-applicable responses. Review each question separately before combining any results.
If you define a satisfied response as 1 or 2 on the original scale, an illustrative calculation is:
Satisfied-response percentage = number selecting 1 or 2 ÷ valid ratings for that question × 100.
For example, 32 satisfied responses out of 40 valid ratings equals 80%. State the question, definition, response count, and exclusions alongside the figure. The Word file does not calculate this automatically, and this percentage is not a Net Promoter Score.
Group comments into themes while preserving their meaning. Respondents may not represent every customer, so avoid treating a small or self-selected response set as a complete picture.
Turn Feedback into Specific Actions
Record the issue, supporting feedback, action owner, and review date. Where a finding points to a process or training change, the training manual templates can help document updated instructions.
Keep feedback results separate from sales measures. The sales channel analysis template provides a separate comparison layout; it does not establish the cause of satisfaction scores. Browse the marketing templates for related planning documents.
Frequently Asked Questions
Is this an online survey?
No. It is a Word document. You can print it or adapt the questions in a separate form service, but no online response collection is included.
Does a higher number mean a better result?
No. In the supplied scale, 1 means Very Satisfied and 5 means Very Dissatisfied.
Can I remove the contact-information section?
Yes. Review what information you need and explain the collection arrangements accurately. Removing that section alone does not guarantee anonymity.
Does it include automatic scoring or charts?
No. Analyze the returned responses separately using a clearly documented method.
Yes. Export a checked copy from Word. A standard PDF export does not automatically make the response circles interactive form controls.










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