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Cancellation Survey Form

Churn exit survey that routes price-sensitive and feature-gap cancellations to a win-back offer.

A ready-to-use surveys & feedback form for product, support and customer-experience teams: 6 questions, 1 page, 4 conditional rules.

Questions
6
Pages
1
Layouts
card · classic
Conditional rules
4
Typical time
2 min
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Live preview and test console

This is the real form. Answer it to test the 4 conditional rules — nothing is sent or stored.

We're sorry to see you go

4 questions are hidden by conditional logic right now — change an answer above to reveal them.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

Who this template is for

Cancellation Survey Form is built for product, support and customer-experience teams who need to measure satisfaction and capture the reason behind every score.

  • Product, support and customer-experience teams working in surveys & feedback.
  • Teams who need to measure satisfaction and capture the reason behind every score without writing code or paying for a custom build.
  • Anyone replacing ratings with no context, so nothing actionable comes out of them with one structured record per enquiry.
  • Respondents are customers, users and members — the form asks them 6 questions across 1 screen.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of ratings with no context, so nothing actionable comes out of them and turns each submission into a record your team can act on immediately.

  • 1 question is required, so submissions arrive complete instead of needing a follow-up email.
  • Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.
  • Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of Cancellation Survey Form lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
  4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
  5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

  • Features advanced show logic: if “What's the main reason you're canceling?” is Too expensive, the form dynamically exposes “Would a discount change your mind?”. Otherwise that question never appears.
  • Features advanced show logic: if “What's the main reason you're canceling?” is Missing a feature I need, the form dynamically exposes “What feature was missing?”. Otherwise that question never appears.
  • Features advanced show logic: if “What's the main reason you're canceling?” is Missing a feature I need, the form dynamically exposes “Notify me if this feature ships”. Otherwise that question never appears.
  • Features advanced show logic: if “What's the main reason you're canceling?” is Switching to another product, the form dynamically exposes “Which product are you switching to?”. Otherwise that question never appears.
  • All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

The moment someone clicks cancel is the last reliable chance to find out why, and this survey is built to use that moment well without turning it into a guilt trip. It leads with a single required question — the main reason for leaving — using categories that map to real retention levers: price, a missing feature, switching to a competitor, no longer needing the product, or poor experience. Each reason branches differently. Anyone who cites price is shown a one-tap discount offer before their cancellation is finalized, since a price objection is often solvable with a lower tier or a temporary discount rather than a full loss. Anyone who cites a missing feature is asked what it was and offered an opt-in to be notified if it ships, which both captures product feedback and keeps the door open for a return without any discount needed. Everyone else moves straight to a short open-text question about what would have kept them, which is lower-pressure than forcing a specific reason to fit. The whole survey is capped at three questions past the initial reason to keep completion high — most people canceling a subscription will abandon a long survey rather than finish it, so brevity matters more than exhaustive detail here.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Before you go

  • What's the main reason you're canceling?required
  • Would a discount change your mind?
  • What feature was missing?
  • Notify me if this feature ships
  • Which product are you switching to?
  • What would have kept you as a customer?

6 questions in total.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 3 behaviours driven by 1 question. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “What's the main reason you're canceling?”

  • Reveals questions

    If “What's the main reason you're canceling?” is Too expensive, the form reveals “Would a discount change your mind?”.

  • Reveals questions

    If “What's the main reason you're canceling?” is Missing a feature I need, the form reveals “What feature was missing?” and “Notify me if this feature ships”.

  • Reveals questions

    If “What's the main reason you're canceling?” is Switching to another product, the form reveals “Which product are you switching to?”.

Set it up step by step

  1. 1

    Trigger the discount offer inline

    Show the discount question immediately after a price-related reason, before the cancellation is confirmed, not in a follow-up email.

  2. 2

    Track feature requests separately

    Route 'missing feature' answers into your product backlog with the notify-me opt-in attached, so you can re-engage when it ships.

  3. 3

    Don't over-ask

    Keep the survey to the branch questions plus one open-text field — long exit surveys get abandoned before the cancellation even completes.

  4. 4

    Segment win-back campaigns by reason

    Send different win-back emails to price-driven vs. feature-driven cancellations rather than one generic 'come back' message.

Mistakes to avoid

  • Asking every canceling customer the same generic 'why are you leaving' with no branching, missing the chance to make a targeted offer.
  • Making the survey mandatory before cancellation completes, which frustrates customers who've already decided and just want to leave.
  • Never following up on the feature-request opt-ins, wasting a clear signal for future win-back outreach.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Send price-sensitive respondents the discount offer immediately, log feature requests with their notify opt-in status, and queue a reason-specific win-back email for everyone else.

Works in both layouts

Browse card templatesBrowse classic templates

Forms that overlap this one

These pages cover the same subject ground as the cancellation survey form, matched on the words people actually search for.

Frequently asked questions

Should I require this survey before cancellation completes?

Keep it optional — forcing it adds friction at the worst possible moment and can generate complaints of its own.

How is this different from the Customer Complaint Form?

This is for someone who has already decided to leave and is exiting; the complaint form is for someone still engaged and looking for a resolution to stay.

What if the discount offer doesn't apply to my product?

Swap it for whichever retention lever fits — a plan downgrade option or a pause option both work in the same slot.

Can I use this for a one-time purchase business instead of a subscription?

Yes, though 'switching to another product' and the discount branch are most useful for recurring subscriptions specifically.

Is the Cancellation Survey Form template free to use?

Yes. You can preview and test Cancellation Survey Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Cancellation Survey Form template ask for?

It asks 6 questions across 1 page, 1 of which is required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Cancellation Survey Form form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the card and classic layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this surveys & feedback form work?

4 conditional rules ship with the template: Features advanced show logic: if “What's the main reason you're canceling?” is Too expensive, the form dynamically exposes “Would a discount change your mind?”. Otherwise that question never appears. Features advanced show logic: if “What's the main reason you're canceling?” is Missing a feature I need, the form dynamically exposes “What feature was missing?”. Otherwise that question never appears. Features advanced show logic: if “What's the main reason you're canceling?” is Missing a feature I need, the form dynamically exposes “Notify me if this feature ships”. Otherwise that question never appears. All rules are editable in the Logic tab.

Where do responses to the Cancellation Survey Form form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Cancellation Survey Form form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

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