FormISPs / Telecom Operators10 questions · ~2 min

Network Issue Report form template

This free Network Issue Report form template helps you let customers report outages, slow speeds or connection problems. It has 10 ready-made questions, takes about 2 minutes to answer, and is anonymous by default. Customise every question, then share it by link, QR code or website embed.

Use this template — free All templates

Questions in this template

Full name *
Short text
Phone number *
Phone number
Account or customer number
Short text
What’s the problem? *
Single choice
No connection · Slow speed · Connection keeps dropping · No mobile signal · Calls failing · Other
Which service?
Single choice
Broadband · Mobile · TV · Business line
When did it start? *
Date
Area, locality or postcode *
Short text
Have you restarted your router or device?
Single choice
Yes · No · Not applicable
Describe the problem
Long text
Best time to contact you
Single choice
Morning · Afternoon · Evening

* required. Every question is editable.

Recommended settings

Visibility: Unlisted — only people with the link
Responses: Anonymous — not linked to accounts
Results: Only you and your workspace see results
One response per: No limit (people can submit for others)
Consent notice: Included — edit it to match your policy

Best for: Issue type, location, when it started.

Industries: IT & Software, Telecommunications.

Best practice for customer support

Ask for a reference number (order, tracking or account) so you can find the case quickly.
Tell people never to send passwords or full card details through the form.
Make the thank-you message honest: a submission isn’t a resolved ticket or an approved claim.

Network Issue Report: frequently asked questions

What questions should a Network Issue Report form include?

A good Network Issue Report form is short and focused. This template asks: Full name · Phone number · Account or customer number · What’s the problem? — plus 6 more. Remove anything you won’t act on.

Is the Network Issue Report form anonymous?

Yes. Responses are anonymous by default and aren’t linked to anyone’s account, although the form asks for contact details so you can reply.

How long does the Network Issue Report form take to complete?

About 2 minutes — 10 questions. Shorter forms get more responses.

Can I customise the Network Issue Report form template?

Yes. Every question, option and setting is editable before you publish, and you can add skip logic, pages, a cover image and translations into 20 more languages, from Chinese, Hindi and Spanish to Arabic, Bengali and Hausa.