Cancellation Survey
Find out why someone is leaving at the moment they decide, and offer the one alternative that might change their mind.
Powered by deoochform
Opens in the builder. Nothing is saved until you edit it.
- Fields
- 8 questions
- Theme
- Rose, switchable in the preview
- Updated
- 11 August 2026
Categories
- Survey
- Survey Forms
- Churn Forms
- Feedback Forms
Ideal for
- Product teams
- Customer success
- Founders
- Growth teams
Best used in
- Churn analysis
- Subscription cancellation
- Win back campaigns
About this template
The cancellation moment is the only time you will get a completely honest answer about your product, and most companies waste it on a confirmation dialog. A single required reason plus one open field is enough to build a churn breakdown you can actually act on.
The offer question is the part that pays for the form. A meaningful share of cancellations are seasonal or budget driven rather than permanent, and offering a pause or a cheaper plan at exactly the moment someone is leaving saves accounts that no win back email will ever reach.
Ask where they are going, because a name that keeps appearing is competitive intelligence you cannot buy. Keep every option honest, including the one that lets them just cancel, since a form that traps people generates complaints rather than retention.
Templates are a starting point, not legal or professional advice. Where a form carries consent, medical, or contractual wording, have somebody qualified review it against the rules that apply to you before you publish.
Fields in this template
- What is the main reason you are cancelling?*Single choice
- Anything you want to add?*Long text
- If you are switching, what are you moving to?Short text
- If something was missing, what was it?Long text
- Would you consider coming back?Single choice
- Before you go, would any of these help?Single choice
- Email on the account*Email
- AccountHidden field
Every field can be renamed, reordered, made optional, or removed once the template is open in the builder.
Related templates
Browse all templates- Customer Feedback Survey
Customer Feedback Survey
How satisfied are you overall?Very satisfiedSatisfiedNeutralHow likely are you to recommend us?What did we do well?Product qualityValue for moneyCustomer supportWhat could we do better?May we follow up about your answers?YesNoEmail addressFind out how customers rate your product or service, and what would make them recommend you to someone else.
- Net Promoter Score Survey
Net Promoter Score Survey
How likely are you to recommend us to a friend or colleague?What is the main reason for your score?What would it take to score us higher?How long have you been a customer?May we contact you about your answer?YesNoEmail addressAccountThe standard two question NPS survey, plus one optional follow up, so you get a trackable number and the reason behind it.
- Product Feedback Form
Product Feedback Form
Which part of the product is this about?What kind of feedback is this?Something is confusingSomething is missingSomething is slowTell us moreHow often does this affect you?How much does it get in your way?Screenshot, if it helpsChoose a fileEmail address, if you want a replyPlanCollect feedback tied to a specific part of the product, so it lands with the team that owns it instead of in a general inbox.