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Churn Exit Survey Form

Ask cancelling customers why they're leaving, what would have kept them and whether they'd consider returning.

A ready-to-use surveys & feedback form for product, support and customer-experience teams: 8 questions, 2 pages, 3 conditional rules.

Questions: 8
Pages: 2
Layouts: classic · card
Conditional rules: 3
Typical time: 3 min

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Live preview and test console

This is the real form. Answer it to test the 3 conditional rules — nothing is sent or stored.

Page 1 of 2 — Before you go

2 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

Churn Exit 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 8 questions across 2 screens.
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.
It scores satisfaction on a consistent scale.
Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.
Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
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.

1Press “Use this template” — a fresh copy of Churn Exit Survey Form lands in your workspace, ready to edit.
2Rename or delete any question, and change what is required. Nothing here is fixed.
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.
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.
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 — 3 conditional rules ship with it.

Features advanced show logic: if “Primary reason for leaving” is Switched to a competitor, the form dynamically exposes “Which product did you switch to?”. Otherwise that question never appears.
Features advanced show logic: if “Primary reason for leaving” is Missing a feature I need, the form dynamically exposes “Which feature was missing?”. Otherwise that question never appears.
Features advanced show logic: if “Would you consider coming back in the future?” is Yes, possibly, the form dynamically exposes “May we contact you to follow up?”. Otherwise that question never appears.
All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

Cancellation itself is a business process — stopping billing and confirming the change — but understanding why it happened is a separate question, and bundling the two into one form usually means the reason gets skipped in the rush to finish cancelling. This exit survey is meant to run right after the cancellation flow, not instead of it, and it treats every question as optional so it never blocks or delays someone who wants to leave quickly. A primary-reason dropdown covers the handful of causes that account for most churn — price, missing features, switching to a competitor, no longer needing the product, poor support experience — and an open text field catches everything a dropdown can't anticipate. A branch for competitor switches asks which product they moved to, which is some of the most commercially useful data a company can collect, since it reveals who it's actually losing deals to. A "what would have kept you" question, phrased as an open invitation rather than a leading prompt, often surfaces fixable product or pricing issues directly from the people who felt them most. The closing question — would they consider returning, and may the team follow up — keeps the door open without pressuring anyone who has already decided to leave.

What this form asks

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

Page 1 — Before you go

Primary reason for leavingrequired
Which product did you switch to?
Which feature was missing?
Anything else that led to this decision?

Page 2 — One more thing

What would have kept you as a customer?
How would you rate your overall experience?
Would you consider coming back in the future?
May we contact you to follow up?

8 questions in total.

How the form changes as it's filled in

This template ships with 3 conditional rules, grouped into 3 behaviours driven by 2 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Primary reason for leaving”

Reveals questions
If “Primary reason for leaving” is Switched to a competitor, the form reveals “Which product did you switch to?”.
Reveals questions
If “Primary reason for leaving” is Missing a feature I need, the form reveals “Which feature was missing?”.

Driven by “Would you consider coming back in the future?”

Reveals questions
If “Would you consider coming back in the future?” is Yes, possibly, the form reveals “May we contact you to follow up?”.

Set it up step by step

1
Run it after cancellation is confirmed, not before
Never make the exit survey a required step to cancel — asking for feedback should never feel like a retention trap.
2
Track the competitor field over time
Which product people switch to is some of the most useful competitive intelligence you'll get, and it costs the customer almost nothing to answer.
3
Read the open text field weekly
The dropdown catches the common reasons; the open field catches everything you haven't thought to ask about yet.
4
Respect a "no follow-up" answer completely
Someone who declines contact has already made a decision — respecting it protects the brand for any future relationship.

Mistakes to avoid

Making the survey a required step before cancellation completes, which reads as a dark pattern.
Only tracking the reason dropdown and ignoring the open-text answers where the real detail lives.
Following up with everyone regardless of their answer to the contact-consent question.

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

Tag responses by reason each month and route feature-related churn to the product team and price-related churn to whoever owns packaging, so patterns get acted on rather than just archived.

Works in both layouts

Browse classic templates Browse card templates

Forms that overlap this one

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

Frequently asked questions

Should this replace the Subscription Cancellation Form?

No — keep them separate. The cancellation form handles the actual account and billing change; this survey is an optional follow-up so the two processes can be measured and improved independently.

Isn't asking for feedback after someone has already cancelled too late?

It's too late to save that particular customer, but the pattern across many exit surveys is exactly what tells you which fixable issues to prioritise before the next batch of cancellations.

What if most people skip the optional questions?

That's expected and fine — even a partial response rate on the reason dropdown gives you a usable trend line over time; don't make fields required just to force completion.

Can I use this data alongside general satisfaction scores?

Yes — compare churn reasons against your regular Customer Satisfaction (CSAT) Survey results to see whether dissatisfaction shows up before people actually leave.

Is the Churn Exit Survey Form template free to use?

Yes. You can preview and test Churn Exit 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 Churn Exit Survey Form template ask for?

It asks 8 questions across 2 pages, 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 Churn Exit Survey Form form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card 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?

3 conditional rules ship with the template: Features advanced show logic: if “Primary reason for leaving” is Switched to a competitor, the form dynamically exposes “Which product did you switch to?”. Otherwise that question never appears. Features advanced show logic: if “Primary reason for leaving” is Missing a feature I need, the form dynamically exposes “Which feature was missing?”. Otherwise that question never appears. Features advanced show logic: if “Would you consider coming back in the future?” is Yes, possibly, the form dynamically exposes “May we contact you to follow up?”. Otherwise that question never appears. All rules are editable in the Logic tab.

Where do responses to the Churn Exit 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 Churn Exit 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.

More forms teams pair with the churn exit survey form.

Related categories

All Surveys & Feedback templates