Customer Loss Survey Evaluation Form

This form helps understand why a customer stopped using the company's services, exploring the factors behind the decision and whether they would consider returning.

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Name

Nombre

Apellido

Age

Phone Number

Email

What attracted you to become one of our customers?

Which company/competitor did you switch to?

Rate the Following Factors

Would you be willing to resume working with us if we improve the areas you were unhappy with?

Yes No Maybe

Is there anything else you'd like to share that would help us improve the customer experience?

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Customer Loss Survey Evaluation Form

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