Feedback Form

Instruction to field researcher: Greet the respondent and ask "do you have a minute to answer a quick survey about online shopping."

To which age group do you belong?

Complete the survey, thank the respondent and find another respondent.

Do you make online purchases?

What do you usually buy online? (select those that apply)

Please describe "Others"

If an item you plan on buying is available at a physical store, would you prefer buying at a physical store or making your purchase online?

Why so?

Why not purchase online?

What can help make you more inclined to make purchases online?


We appreciate your time!

(optional) Customer's name and signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.