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Cannabis Customer Feedback Questionnaire

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Cannabis Customer Feedback Questionnaire and Feedback Submission Agreement

Recitals

This Agreement is entered into between Business Name: (the "Company") and Customer Name: (the "Customer") for the collection and permitted use of the Customer's feedback concerning cannabis products and services.

WHEREAS, Company operates licensed cannabis retail and/or testing operations and seeks to collect reliable consumer feedback to improve product quality and services; and

WHEREAS, Customer voluntarily provides feedback regarding purchases, consumption experience, and related observations and may receive remuneration as specified below.

Scope of Work

The Customer agrees to provide truthful observations, ratings, and other responses as requested in this Questionnaire. Company may request follow-up clarifications and the Customer will reasonably cooperate with such follow-ups.

Payment Terms

Compensation Amount:    Payment Schedule:

Late Payment Fee (if applicable):

Customer acknowledges that any compensation is payment for the time and information provided and does not constitute an endorsement of products by regulatory authorities. Company retains no obligation to provide compensation if Customer breaches representations contained herein.

Term and Termination

Term Start Date:

Term End Date:

Either party may terminate this Agreement for convenience upon written notice to the other party delivered at least prior to termination. Termination does not relieve either party of obligations accrued prior to termination.

Confidentiality

Except as provided in this Agreement, both parties agree to treat non-public information supplied by the other as confidential and to use such information only for the purposes of fulfilling obligations under this Agreement. Confidential information excludes information that is or becomes publicly available through no fault of the receiving party, is independently developed, or is lawfully received from a third party without restriction.

Customer may indicate whether feedback may be used in Company marketing materials:

Consent and Release

Customer represents and warrants that any feedback, photographs, or other materials provided are original and that Customer has all rights necessary to grant Company the license set forth below. Customer hereby grants Company a perpetual, worldwide, royalty-free license to use, reproduce, modify, publish, translate and distribute Customer's feedback and supplied materials consistent with the consent selection above. Customer releases Company from liability for lawful use of feedback in accordance with this Agreement.

Governing Law

This Agreement will be governed by and construed in accordance with the laws of the State of , without regard to principles of conflicts of law.

Entire Agreement

This Agreement, together with any attached questionnaires or addenda, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written.

Customer Feedback Questionnaire

Purchase Date:

Overall Experience:

Effectiveness:

Aroma/Flavor:

Would you recommend this product to others?

May we contact you to follow up on your responses?

Acknowledgment

By signing below, the parties acknowledge that they have read and understand this Agreement, that the Customer's feedback is voluntary, and that the Customer has authority to provide any materials submitted. The Customer further confirms that they are of legal age to purchase cannabis in the applicable jurisdiction.

Company Name:

By:

Date:

Customer Name:

By:

Date:

Enter text✕

What the Cannabis Customer Feedback Questionnaire Is

The Cannabis Customer Feedback Questionnaire is a structured, fillable form used by licensed cannabis retailers, cultivators, and product manufacturers to collect standardized feedback from purchasers and patients. It captures user experience data on product quality, packaging, labeling, adverse reactions, and service interactions while preserving consent and basic contact details for follow-up. Designed for regulatory and operational use, the questionnaire can be distributed in person, by email, or through a secure eSignature workflow to support quality improvement, recall readiness, and compliance with state consumer-safety reporting expectations.

Why a Standardized Questionnaire Matters

A consistent feedback form helps identify product issues early, documents customer complaints for compliance, and creates auditable records for remediation. Accurate feedback supports product safety, regulatory reporting, and quality improvements without replacing clinical or legal reporting obligations.

Why a Standardized Questionnaire Matters

Who Typically Uses This Questionnaire

Licensed dispensary managers, product quality teams, compliance officers, and customer service staff commonly issue or collect this questionnaire.

Completed questionnaires create a single record that supports follow-up, trend analysis, and retention policies required by regulators and internal quality programs.

Step-by-step: Collecting and Submitting Feedback

Follow these sequential steps to ensure feedback is captured, validated, and routed for review.

  • 01
    Record Intake: Offer the form at sale or after use; confirm identity and product details.
  • 02
    Complete Fields: Customer or staff fills required fields and describes the experience.
  • 03
    Verify Accuracy: Check batch numbers, dates, and contact info before submission.
  • 04
    Route for Review: Send to QA/compliance team with timestamped audit trail.

Typical Digital Workflow for the Questionnaire

A standard e-distribution workflow reduces friction and creates an auditable trail for each submitted questionnaire.

  • Upload Template: Import the questionnaire PDF or DOCX into your eSignature platform.
  • Place Fields: Add name, date, product, description, and consent fields.
  • Send to Customer: Email or SMS a signing link or provide a kiosk link in-store.
  • Capture Audit Trail: Record signer IP, timestamp, and method of authentication.

Recommended Online Configuration Settings

Configure these settings when deploying the questionnaire in an eSignature or form platform to balance access and verification.

Field Configuration
Authentication Email link or SMS code for customer validation
Required Fields Name, product identifier, date of use, description, consent
Retention Policy Automatic export to secure storage with access logging
Notifications Auto-notify QA and compliance teams on submission

Technical Considerations for eSubmission

Ensure the platform you use supports secure form hosting, required authentication, and an audit trail.

  • Formats Supported: PDF, DOCX, HTML
  • Integrations: CRM or storage systems like Salesforce or Box
  • Security: TLS in transit and AES-256 at rest

Verify that the chosen solution provides exportable signed PDFs and searchable metadata to support audits and regulatory requests.

Core Components of a Professional Questionnaire

Include these elements so submissions are actionable, auditable, and suitable for regulatory review.

Identifying Data

Customer name, contact, and product identifiers to trace reports to batches and purchasers.

Event Details

Date/time of use, onset, duration, and symptom details for clinical triage and investigation.

Packaging and Labeling

Notes on tampering, mislabeling, or missing warnings important for compliance and recalls.

Consent and Permissions

Explicit consent for contact, data retention, and sharing with regulators if required.

Severity Assessment

A simple scale or checkbox set to flag serious adverse reactions needing immediate escalation.

Audit Metadata

Time, uploader, IP, and signature evidence to preserve chain-of-custody.

Essential Data Elements to Capture

Customer Name: Full legal name
Contact: Phone or email
Product Info: SKU | batch | lot
Event Date: MM/DD/YYYY
Symptoms: Description
Consent: Yes/No

Common Preparation Errors to Avoid

  • Collecting incomplete batch information, making traceability difficult for recalls.
  • Using free-text only fields without prompts, increasing inconsistent or unusable responses.
  • Failing to capture consent to contact, preventing follow-up when required.
  • Not preserving audit metadata (IP, timestamp), weakening evidentiary strength.

Risks if Reports Are Missing or Incomplete

Regulatory Action: State enforcement or fines for inadequate incident documentation
Recall Delays: Slower batch tracing can expand public exposure
Liability Exposure: Incomplete records increase civil risk in claims
Operational Impact: Inability to identify systemic product defects
Data Integrity: Lost metadata reduces credibility of reports
Customer Trust: Perceived poor response can harm reputation

eSignature Pricing Comparison Relevant to Questionnaire Workflows

Price and feature trade-offs affect how you distribute and retain signed questionnaires; signNow is listed first per comparison conventions.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Free trial available Free trial available Free trial available Free trial available
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently Asked Questions about the Questionnaire

Answers to common operational, legal, and technical questions when using the Cannabis Customer Feedback Questionnaire.


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