Sample Customer Feedback Survey

This is a preview of the customer survey form.
It’s exactly what your customers would see when they scan your QR code to rate their experience.
All fields are disabled in this preview mode.

Rate Sample Station

Service Experience

How friendly was the service? (1 - Poor, 5 - Excellent)

How fast was the service? (1 - Very Slow, 5 - Very Fast)

Cleanliness

How clean were the bathrooms? (1 - Very Dirty, 5 - Very Clean)

How clean was the station overall? (1 - Dirty, 5 - Spotless)

Safety & Availability

How safe did you feel at the station? (1 - Unsafe, 5 - Very Safe)

How would you rate the availability of fuel and shop products? (1 - Poor, 5 - Excellent)

Overall

Would you recommend this station to others? (1 - Definitely Not, 5 - Definitely Yes)

Any additional comments?

Phone Number (optional, to enter our monthly draw) Optional – enter to be eligible for the monthly prize draw at this station. Your number is only shared with this station for prize or feedback follow-up.