When to use it
This is a report form rather than a satisfaction survey. Put the link wherever a customer with a problem will look for help: your contact or help page, the website footer, and the order confirmation email with a line such as "Something wrong with your order? Tell us here." Then it's already in place on the day it's needed. If you link it from a Shopify order email, the order number travels in the link as ?ref=, so the customer can skip that question.
Why these questions
The form starts by asking what went wrong, with four plain options: damaged, wrong item, missing item, or the wrong size, colour or variant. Each one leads to a different fix and often a different person in your team, so you can sort incoming reports at a glance.
The order number comes next. It's optional, because some customers won't have it to hand. The open question then asks which item was affected and what happened, and its description asks whether the outer box was damaged too. That one detail helps you separate damage in transit from a mistake at packing.
The customer then picks the outcome they want: a replacement, a refund, the missing item, or not sure yet. Asking up front saves a round of emails and stops you offering a refund to someone who simply wants the right product.
Last is a contact question for name, email and phone. Every field is optional, and its description explains that you need at least one way to reach them to sort out the order. A report from your website can't be matched to anyone without it.
Photo uploads aren't part of the Free plan, so the end screen asks customers to reply to your email with a photo if they have one. On Pro you can add a file upload question instead.
Why there's no automatic coupon
A coupon that pops up the instant someone reports a broken item reads as a brush-off: here's a discount, please go away. What the customer wants is the right product or their money back. So this template shows no coupon. Fix the problem first. Once the replacement is on its way or the refund has gone through, send a code by hand with your apology, created in your store's discount settings. A personal message with a code, after the fix, does much more for the relationship than an automatic one before it.
What to do with the reports
Reply to every report, and try to do it within a working day. Each month, count reports by type. A run of wrong items points at picking and packing; damage clustered on one product points at how it's packed, which the packaging and unboxing survey can help with. If returns are part of the fix, the returns and exchanges survey covers the reasons behind them.