what is customer feedback form

Client Experience and Service Evaluation Form

Instructions for Use

• Complete all bracketed fields to ensure the document is legally and operationally aligned with your current business practices.
• Distribute this form to the client via a secure channel and maintain a record of the submission date for your internal quality assurance logs.
• Upon receipt of the completed form, ensure that any sensitive personal data is processed in accordance with your organization’s Privacy Policy and applicable data protection regulations.

Parties & Definitions

This evaluation is entered into by and between [Company Name], located at [Company Address] ("Provider"), and [Client Full Legal Name], located at [Client Address] ("Client").

1. Service Period: This evaluation covers the professional services rendered between [Start Date] and [End Date].
2. Project Reference: The specific engagement associated with this feedback is [Project/Contract Number].

Operative Terms

1. Scope of Feedback: The Client agrees to provide honest and accurate feedback regarding the performance, communication, and deliverables provided by the Provider during the Service Period.
2. Use of Testimonials: By checking the box below, the Client grants the Provider a non-exclusive, royalty-free, perpetual license to use the feedback provided herein for marketing and promotional purposes, including the right to edit for clarity, provided the core meaning remains unchanged.
   • I grant permission for my feedback to be used in marketing materials.
   • I do not grant permission for my feedback to be used in marketing materials.
3. Confidentiality: The Provider agrees to treat the identity of the Client as confidential if requested in the "Additional Comments" section below.
4. Data Retention: Feedback provided will be retained by the Provider for a period of [Number] years for internal performance auditing and service improvement.
5. Client Rating: Please rate the following on a scale of 1 to 5 (1 = Poor, 5 = Excellent):
   • Timeliness of Deliverables: [__________]
   • Professionalism of Staff: [__________]
   • Quality of Final Output: [__________]
6. Additional Comments: [__________]

Signature & Acknowledgment

By signing below, the Client acknowledges that the information provided is accurate to the best of their knowledge and agrees to the terms of use outlined in Clause 2.

Signature: __________ Printed Name: [] Title: [] Date: [__________]

Legal Disclaimer: This document is a general framework intended for informational purposes only. It does not constitute legal advice. You must consult with qualified legal counsel in your specific jurisdiction to ensure compliance with local consumer protection laws, privacy regulations (such as GDPR or CCPA), and industry-specific requirements.