What is your name?
What is your Email?
What is your relationship with our brand? Customer/ClientEmployeePartnerOther (Please specify)
Please describe your concern or complaint in detail
How would you rate your overall experience with our brand? (1-5 scale) 12345
What specific issues have you encountered? (Select all that apply) Service QualityCustomer ServicePricingOther (Please specify)
How often do you experience these issues? FrequentlyOccasionallyRarelyNever
What suggestions do you have for improving our services or products?
Would you be willing to discuss your concerns further? YesNo
If yes, please provide your preferred contact method.
Is there anything else you would like to share with us?
