Customer feedback form template
Collect private feedback; reviews are not published automatically.
Local preview: changes stay in this browser. No message or email is sent.
Customer feedback
An optional rating and comment to improve your service.
LittleReplyCustomize the template
Add your identity, purpose, applicable basis, retention, rights contact, and privacy link. This example is not legal advice.
Standalone HTML / CSS
<!doctype html>
<html lang="en"><head><meta charset="utf-8"><meta name="viewport" content="width=device-width,initial-scale=1"><title>Contact form</title>
<style>form[data-littlereply]{max-width:640px;margin:2rem auto;padding:1.5rem;font:16px/1.6 system-ui,sans-serif;color:#202033;background:white;border:1px solid #e4e4ee;border-radius:16px;box-sizing:border-box}form[data-littlereply] label{display:block;margin-top:1rem;font-weight:600}form[data-littlereply] input,form[data-littlereply] textarea,form[data-littlereply] select{box-sizing:border-box;width:100%;padding:.75rem;font:inherit;border:1px solid #727285;border-radius:8px;background:white;color:#202033}form[data-littlereply] input[type=checkbox],form[data-littlereply] input[type=radio]{width:auto}form[data-littlereply] button{margin-top:1rem;padding:.8rem 1.1rem;font:inherit;font-weight:600;border:0;border-radius:8px;background:var(--form-accent,#4f46e5);color:white;cursor:pointer}form[data-littlereply] :focus-visible{outline:3px solid #f59e0b;outline-offset:3px}form[data-littlereply] button:disabled{opacity:.6}form[data-littlereply] [role=status]{min-height:1.6em}form[data-littlereply] fieldset{border:0;padding:0}form[data-littlereply] .privacy-notice{font-size:.875rem;color:#4b4b60}
form[data-littlereply]{--form-accent:#4f46e5;--form-ink:#ffffff}
form[data-littlereply] button{color:var(--form-ink)}form[data-littlereply] button[data-fq-back]{background:#eee;color:#202033}form[data-littlereply] [hidden]{display:none}</style></head><body>
<form action="https://littlereply.com/api/submit" method="POST" data-littlereply="YOUR_ACCESS_KEY" data-locale="en" data-success="Your feedback has been stored. Thank you.">
<input type="hidden" name="_fq_key" value="YOUR_ACCESS_KEY" />
<input type="text" name="botcheck" tabindex="-1" autocomplete="off" style="display:none" aria-hidden="true" />
<label for="fq_name">Your name (optional)</label>
<input type="text" name="name" id="fq_name" autocomplete="name" />
<label for="fq_email">Your email (optional)</label>
<input type="email" name="email" id="fq_email" autocomplete="email" />
<label for="fq_rating">Your rating (optional)</label>
<select name="rating" id="fq_rating"><option value="">—</option><option>1</option><option>2</option><option>3</option><option>4</option><option>5</option></select>
<label for="fq_message">Your feedback *</label>
<textarea name="message" id="fq_message" required maxlength="5000" rows="5"></textarea>
<button type="submit">Send my feedback</button>
<p role="status" aria-live="polite"></p>
</form>
<!-- Accessible AJAX errors and duplicate-safe retries -->
<script src="https://littlereply.com/client/v1.js" data-api="https://littlereply.com" defer></script>
</body></html>Replace YOUR_ACCESS_KEY with your form's public key. The code includes its styles and an AJAX enhancement; the native HTML POST also works without JavaScript.
Install this template
- An email address is useful only if you plan to reply.
- Ask for separate permission before publishing an identified testimonial.
- Create your form using “Use this template”. Its fields and your customizations will carry over.
- Verify the recipient, publish the form, then replace the key in the copied code.
- Send an identified test and inspect the stored message and then its delivery.
Frequently asked questions
Is the feedback shown on my website?
No, it arrives in your private inbox.
Can someone respond without an email address?
Yes. You can read the feedback but cannot contact the author.