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📊 Assessment Template

Free Customer Success & Churn Risk Assessment Form Template

Evaluate your key account health across 5 dimensions with an interactive AI form. Upon completion, a personalized PDF account health report is automatically generated — printable for professional delivery, with an embedded QR code that lets CSMs chat with an AI consultant about retention strategies.

5 Dimensions
~10 min
AI PDF Report
AI Consultant
Live Preview
Sample Report — Account Health
UsageRelationshipROISupportRenewal Risk 6572485538
56/ 100
Overall Account Health Score

Quick answer

Free customer success and churn risk assessment template for B2B SaaS teams — account health across 5 dimensions; printable AI PDF report per response.

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Live Preview

This is the actual running assessment — not a screenshot. Try it yourself.

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Loading churn risk assessment form...
This is the actual churn risk assessment form your CSMs will use. Complete it to automatically generate a personalized, printable PDF account health report.
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Loading AI report preview...
Sample AI report with Churn Risk Score, account health dashboard, and intervention playbook. Printable for professional delivery. Each PDF includes a QR code to start an AI consultant chat.
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Loading AI consultant preview...
AI consultant trained on customer success best practices and churn prevention. Scan the QR code on your PDF report to discuss retention strategies.
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What's Included

Everything you need to run a professional churn risk assessment.

1

Interactive Account Health Assessment Form

5-dimension account health questionnaire — Product Usage, Executive Relationship, ROI Achievement, Support Health, and Renewal Risk. Covers critical indicators including usage trends, sponsor status, support ticket volume, NPS scores, and competitor threat levels. Upon completion, a personalized PDF account health report is automatically generated.

2

Printable PDF Account Health Report

Professional, print-ready PDF with Churn Risk Score classification (Low, Medium, Critical), traffic-light health indicators across Usage, Relationship, and ROI dimensions, and a tailored Intervention Playbook with specific save strategies. Designed for team reviews and executive briefings. Each PDF includes a QR code.

3

AI Consultant via QR Code

Each PDF report embeds a unique QR code. Scan it with any phone camera to instantly open an AI consultant chat — trained on customer success and churn prevention — where CSMs can discuss intervention playbooks and get personalized retention strategies.

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Who Is This For

Pick your role — see how the template fits your workflow.

1

Customer Success Managers

Proactively assess account health and prevent churn before it happens. Workflow: Copy template → Customize for your product → Fill out for each key account → Get personalized intervention playbook from AI report.

2

VP of Customer Success

Get a standardized view of portfolio risk across all accounts. Workflow: Import template → Define scoring criteria → Share with CSM team → Review aggregated churn risk data and prioritize executive interventions.

3

SaaS Founders & Revenue Leaders

Understand why key accounts are at risk and what to do about it. Workflow: Complete the assessment → Get personalized PDF report → Scan QR code for AI-powered retention discussion → Take targeted action to save at-risk revenue.

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Sample Questions Inside

A preview of real questions from this template — the full version adds scoring logic, branching and a personalized report per respondent.

  1. What was the last measured NPS for this account? (0-10)
  2. Has product usage declined over the last 90 days? (trend choice)
  3. How many support tickets were filed last quarter, and trending? (number + direction)
  4. When does the contract renew? (date / range)
  5. Is your internal champion still active in the account? (yes / changed / unknown)
  6. Any late payments or procurement friction recently? (choice)
  7. Did the admin complete onboarding success milestones? (yes / partial / no)
  8. How many competitors is this account actively evaluating? (number)
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Frequently Asked Questions

What is a Customer Success & Churn Risk Assessment?
A Customer Success & Churn Risk Assessment evaluates the health of your key B2B accounts across five dimensions — Product Usage, Executive Relationship, ROI Achievement, Support Health, and Renewal Risk. It helps Customer Success Managers proactively identify at-risk accounts and take action before churn happens.
How long does it take to complete the churn risk assessment form?
The Customer Success & Churn Risk Assessment form typically takes 8-12 minutes to complete. It covers 10 critical account health indicators including usage trends, executive sponsor status, support ticket volume, NPS scores, and competitor threat levels. Upon completion, a personalized PDF account health report is automatically generated.
Can I customize this churn risk assessment form template for my team?
Yes. Click "Use This Template" to copy the full assessment into your FormLM workspace. You can then customize health dimensions, scoring weights, renewal timeline options, and report content to match your customer success methodology and product.
What does the AI report include?
The AI report includes an Account Health Dashboard with Churn Risk Score classification (Low, Medium, Critical), traffic-light indicators for Usage, Relationship, and ROI dimensions, and a tailored Intervention Playbook with specific save strategies based on the identified risk factors. Reports are auto-generated as personalized, printable PDFs — designed for professional delivery. Each PDF includes a QR code that links directly to an AI consultant chat.
What is the QR code on the PDF report for?
The QR code on each PDF report links to an AI consultant chat. Scan it with any phone camera to start a conversation about your account assessment — discuss intervention playbooks, explore retention tactics, and get personalized save strategies. No login or app required.
How is this different from Gainsight or ChurnZero?
Unlike Gainsight or ChurnZero that are expensive customer success platforms requiring technical integration and long implementation cycles, this template is a questionnaire-based assessment that any CSM can deploy immediately. It auto-generates personalized printable PDF account health reports with intervention playbooks, and embeds a QR code in each PDF that links to an AI consultant chat for retention guidance. CS platforms monitor data; FormLM helps you act on it.

Start Your Churn Risk Assessment Today

Copy the Customer Success & Churn Risk Assessment into your workspace, customize it for your product, and share it with your CSM team. Free to start.