A customer acceptance questionnaire, as is explained by the term itself, is a document that puts questions regarding the customer’s acceptance of a particular product or service. All products or services are directed towards specific clients and are successful only when totally accepted by the customers.

Hence, the customer acceptance rate needs to be measured at regular intervals, or at required times after release of products or launch of specific services. The format of the questionnaire should be such that it includes questions on all the major factors that help determine the acceptance of a certain product by customers – new or regular.

Customer Acceptance Questionnaire Sample

Name of product/service: ______________

Company title: ___________

Customer name: __________________

Permanent address: _________________________________

Contact number: ______________                                     Email address: ________________

Q1: Do you think the product/service to be an effective one?

  • Yes, totally effective
  • Somewhat effective
  • Does not work most of the time
  • Not at all effective

Q2: Does the product/service help you in your daily life/business ventures?

  • Yes, I completely rely on it
  • It is sometimes required
  • Hardly required
  • No, it is a complete waste

Q3: Does the design of the product appeal to you?

  • Yes, it is outstanding and indeed attractive
  • The design is good
  • It could have been much better
  • Poorly designed

Q4: How do you perceive of the functionality of the product based on the following parameters?

  1. Completeness: ______________


  1. User-friendly nature: _____________


  1. Ease of installation: _____________


  1. Ease of use: ______________


  1. Level of automation: _____________


Q5: How do you find the price of the product?

  • The pricing is very suitable
  • Price is O.K
  • Price is slightly high
  • Price is extremely high; not affordable

Q6: How does the product fare in comparison to other products on the basis of the following parameters?

  1. Performance: ____________


  1. Design and packaging: ___________


  1. Quality: _________


  1. Pricing: _________