Complaint Form
Record complaints in a structured way: item and order details, the type and description of the defect, when it appeared and the remedy the customer wants — with a note on voluntariness and data minimization.
Take the template with one click, adapt it to your project in a few minutes and start collecting answers.
Why this template
Adapted in minutes
Change, add or remove questions — the AI assistant rephrases them on request.
Free to start
Publish the template on a free account — no credit card and no trial clock.
Results in real time
Charts, filters and export to Excel, SPSS or CSV — with no extra work.
How to use this survey
- 1
Take the template
Create a free account and copy the template into your project with one click.
- 2
Adapt the questions
Adjust wording, scales and logic to your context — as often as you like.
- 3
Invite respondents
Share it by link, QR code, email or embedded on your website.
- 4
Analyse the answers
A live dashboard with charts, filters and export into your analysis tool.
The questions in this template
- Which item is this about?
- What is your order or invoice number?
- When did you buy or receive the item?
- What is wrong with the item?
- Please describe the defect.
- When did the defect first appear?
- Can you provide photos or a short video of the defect?
- Which solution would you prefer?
- What is your first and last name?
- Which email address may we contact you at?
- On which phone number can we reach you if we have questions?
- Is there anything else we should know about this case?
All 12 questions are fully editable.
Frequently asked questions
Is the “Complaint Form” template free?
Yes. You can use, customize and publish the template for free — a free account is all you need.
How do I use the “Complaint Form” template?
One click on “Use this template” creates it as your own survey in the editor. From there you can adapt it and share it by link, QR code, email or embedded on your own website.
Can I change, delete and add questions?
Completely. Once taken, the survey sits in your editor: every question, scale and answer option can be edited, reordered or removed.
What data does the “Complaint Form” template collect?
Which data you collect is decided question by question — if you don't ask for personal data, none is collected. Every question in the template can be changed or removed before you publish.
Are surveys built from the “Complaint Form” template secure and anonymous on empirio.ai?
Respondents need no account and simply open the link. Whether answers stay anonymous is up to the questions you ask: as long as nothing personal is asked, no answer can be traced back to a person.