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Customer success health check survey form template
Turn account check-ins into actionable signals about outcomes, adoption, risk, and the help a customer wants next.
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Best for
Customer success, account management, product, and support teams
- 1Account and role
- 2Outcome progress
- 3Adoption friction
- 4Renewal confidence
- 5Requested help and consent
Ways to use this template
- Quarterly business reviews
- Onboarding checkpoints
- Renewal preparation
What to include
A strong template is more than a list of questions. It should capture the right data, make the next step obvious, and keep the response clean enough to analyze or route.
1
Account and role
Account and role keeps the customer success health check survey response structured for routing, review, export, and follow-up.
2
Outcome progress
Outcome progress keeps the customer success health check survey response structured for routing, review, export, and follow-up.
3
Adoption friction
Adoption friction keeps the customer success health check survey response structured for routing, review, export, and follow-up.
4
Renewal confidence
Renewal confidence keeps the customer success health check survey response structured for routing, review, export, and follow-up.
5
Requested help and consent
Requested help and consent keeps the customer success health check survey response structured for routing, review, export, and follow-up.
Separate risk from opportunity signals
Route follow-up to the account owner
Compare health trends over time
Pair this template with the right feature
The template gives you the starting structure. The related product capability helps turn submitted answers into a working response workflow.
Connect the workflow
What should a customer health check measure?
Ask about progress toward outcomes, adoption barriers, confidence, risks, wins, and the help the customer wants next.
Is a health check the same as an NPS survey?
No. NPS is one sentiment signal; a health check adds outcome and adoption context that teams can act on.
Can responses trigger follow-up?
Yes. Route risk, expansion, or support signals to the account owner and record whether follow-up was requested.
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