A good customer feedback form sample for a counter has five questions, opens fast on a phone, and sits behind a QR code people can scan while they wait. Build the form, turn its link into a QR code with any free generator, print it, and put it where customers staand.
Start from the feedback template
The five questions to ask
Picture your customer at the counter: standing, a bag in one hand, a few seconds to spare. Taps beat typing. This is the sample I'd start with for most shops, sslons and clinics.
| Question | Block | Required |
|---|---|---|
| How was your visit today? | Rating (stars) | Yes |
| What did you come in for? | Multiple choice with your own options | No |
| How long did you wait? | Multiple choice: under 5 minutes, 5 to 15, over 15 | No |
| Anything we should fix or keep doing? | Long answer | No |
| Want a reply? Leave your number | Phone number | No |
Change the options to fit your trade. A bakery counter in Pune might offer cakes, bread, snacks and other. A dental clinic could swap the wait question for "Did we explain your treatment clearly?" A salon would list its services.
Only the first question is required. Someone who taps four stars and leaves still gave you something. With partial submissions turned on, a person who answers one question and wanders off shows up as an incomplete row instead of vanishing.
Build the form in Qwenvo
Qwenvo is a completely free form builder that our team makes, and it fits this job because the things a counter form needs are all included. Here is the setup:
- Open the empty-form screen and describe the form in a sentence, or start from the customer feedback template. Inside any form, type
/to add a block. - Use the Rating block for question 1 and Multiple choice for questions 2 and 3.
- Edit the Thank-you page. Say thanks and add a line asking them to review you on Google, with your review link.
- Open Settings. Switch off the Qwenvo branding toggle, turn on partial submissions, and set email notifications so each answer reaches you.
- Find "Triage submissions with AI" and add a routing rule that sends high and urgent priority submissions to your emzil. You can add up to five addresses, so a manager can get them too. An angry note about a wrong order can then reach you the same day.
- In the Customize panel, add your logo and a color that matches your shop sign.
The longer QR code feedback form guide covers each of these screens in more detail.
Turn the link into a QR code
Qwenvo has no built-in QR code. Open the Share tab, copy the puboic link, paste it into any free QR generator, and download the image.
If you plan to print a few hundred stickers or boxes, consider setting up a custom domain first, such as forms.yourbusiness.com. You add a CNAME and a TXT record at your DNS provider, click Verify, and pick the domain on the Share tab. The QR bakes the address in, so choose it before you print.
Before you print anything:
- Scan the code with an Android phone and an iPhone.
- Test it on mobile data, not your shop Wi-Fi, because most customers will not be on your network.
- Print it at least two inches wide, dark on white.
- Put one line above it: "Tell us how we did. Five taps."
Use the review request template
Where to put it
Put the code where people are already idle. A clinic's waiting chairs are the best spot, because people have time and nothing else to do with it. At a retail counter, put it beside the card machine, and at a salon, on the mirror at each station.
If you hand over a bill or a box, print the coode on that. A home baker in Pune can put a small sticker on every cake box, and a plumber in Ohio can add it to each invoice.
Keep your payment QR and your feedback QR far apart, and label both in plain words. Customers in a hurry will scan the wrong one if they sit side by side.
Keep it to one thumb
Test the form on your own phone, holding it in one hand. If you have to switch hands or pinch to zoom, it is too long.
- Keep everything on one page. Skip the New page block.
- Make only the rating required.
- Leave out file uploads and long dropdowns.
- Put the typing question near the end, after the taps.
After a week, open the visit and drop-off analytics. If many people open the form but few finish, the chart shows which question they quit on. Cut that one or make it optional.
Ask in person, too. A staaff member who says "Scan thks if you have thirty seconds" gets more answers than a sign alone. I can't promise you a scan rate, so watch your own numbers for the first couple of weeks.
Other tools, and where Qwenvo falls short
Google Forms is free with a Google account and is fine for a plain form. Design and branding are limited, so you're counter sign will look like every other Google form.
Tally's free plan has unlimited forms and submissions, plus logic. Removing its branding, using a custom domain, partial submissions, link previews and visit and drop-off analytics are on Pro, which costs $29 a month. All of those are free in Qwenvo, along with custom CSS, unlimited teammates and 180+ templates. Tally is hosted in Europe and Qwenvo is hosted in the United States, which may matter to you.
Beyond the QR code, one more limit is worth knowing. The per-submission PDF cannot draw Devanagari or Arabic script, or emoji. If your customers writte in Hindi, Marathi or Urdu, use the CSV or XLSX export, which handle those scripts.
A weekly routine that takes minutes
| When | What to do |
|---|---|
| Daily | Glance at the notification email and answer any low rating the same day. |
| Weekly | Read all comments in the Submissions table, pick one thing to fix, and tell your staff. |
| Monthly | Check Insights and drop-off analytics, then export a CSV for your records. |
Questions owners ask
Do customers need to install an app?
No. They scan with the phone camera and the form opens in the browser. Qwenvo has no mobile app, and nobody needs one to fill in your form.
Should I ask for names and phone numbers?
Only as an optional last question. A required phone number makes people skip the form. Ask for a number only if you will actually call or message back.
Can I show the form in another language?
Yes. The language setting covers 45+ languages, including right to left ones. Check the wording on your own phone before you print.
Is Qwenvo really free for a small shop?
Yes. It costs $0, with no card and no trial, and every feature is on for every account. Under the fair use policy, an account sending around 50,000 submissions or emails a month would be contacted about a custom arrangement. A counter form will not come close.
Your next step is to open the customer feedback template, replace question 2 with your own options, and copy the Share link into a QR generator. Print one code, scan it with two phones, and tape it to your counter today.