Gym Membership Cancellation & Exit Feedback Form

Collect cancellation reasons and honest exit feedback from departing gym members to reduce churn and improve your fitness facility.

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Gym Membership Cancellation Reason & Exit Feedback Form

Full Name

· · ·

Email Address

· · ·

Phone Number

· · ·

Submit

The Gym Membership Cancellation Reason & Exit Feedback Form is designed to help fitness centers, gyms, and health clubs professionally handle membership cancellations while capturing valuable insights from departing members. It collects essential member details, cancellation dates, and the primary reasons why members choose to leave.

This template is ideal for gym owners, membership managers, and operations teams who want to understand member churn and identify areas for improvement. With structured rating questions, NPS-style likelihood-to-recommend prompts, and open-ended fields, you gain a complete picture of the member experience from start to cancellation.

By gathering actionable exit feedback — including what changes could win members back — you can refine your offerings, address recurring pain points, and ultimately improve member retention. Use this free template to turn cancellations into opportunities for growth and service excellence.

3 Pages

18 Questions

~6min To complete

Free No credit card needed

Field types Long Text ×3 Date ×2 Full Name Email Phone Short Text Dropdown Multiple Choice Star Rating Likert Scale NPS Score Yes / No Single Choice termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Member Information 7 questions

Member Details

1 Full Name * Full Name

2 Email Address * Email

3 Phone Number Phone

4 Membership ID / Account Number * Short Text

5 Membership Type * Dropdown

6 Membership Start Date * Date

7 Requested Cancellation Date * Date

Page 2 Cancellation Reasons & Feedback 5 questions

Why Are You Cancelling?

1 Primary Reason(s) for Cancellation * Multiple Choice

2 Please share more details about your reason(s) for leaving Long Text

Your Experience With Us

3 How would you rate your overall gym experience? * Star Rating

4 Please rate the following aspects of our gym * Likert Scale

5 How likely are you to recommend our gym to a friend or colleague? * NPS Score

Page 3 Final Thoughts & Confirmation 6 questions

Anything Else We Should Know?

1 Did you attempt to resolve any issues with our staff before deciding to cancel? * Yes / No

2 What could we have done differently to keep you as a member? Long Text

3 Would you consider rejoining in the future? * Single Choice

4 If we made improvements, what specific change would bring you back? Long Text

Thank you for being a valued member. Your honest feedback helps us improve the experience for current and future members. Please confirm your cancellation request below.

5 I confirm that I wish to cancel my gym membership and understand that any applicable cancellation terms per my membership agreement will apply. * termsandconditions

6 Member Signature * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.