Customer Experience Health Check Form

Customer Excellence (CX) Maturity Self-Assessment

Assess how well your organization delivers on customer expectations and where trust may be breaking down!

Section 1: Participant Information
1. Full Name: *

First NameLast Name
Email Address*
example@example.com
3. Job Title/Role:*
4. Organization/Company Name:*
5. Country / Region*

Section 2: Assessment
6. How consistent is your service delivery across teams and channels?

1 – Highly inconsistent2 – Frequently inconsistent3 – Somewhat consistent4 – Mostly consistent5 – Highly consistent
7. How confident are you that your teams understand what matters most to customers?

1 – Not at all2 – Slightly confident3 – Moderately confident4 – Mostly confident5 – Extremely confident
8. How visible are customer-impacting issues to leadership and frontline teams?

1 – Not visible2 – Rarely visible3 – Sometimes visible4 – Mostly visible5 – Very visible
9. How quickly are breakdowns in service (e.g., delays, dropped handoffs) detected and addressed?

1 – Very slowly or not at all2 – Slowly, with frequent delays3 – Inconsistently addressed4 – Generally addressed quickly5 – Quickly and effectively every time
10. How well are handoffs between functions or systems working today?

1 – Frequently broken2 – Often unclear or missed3 – Inconsistently managed4 – Generally smooth5 – Consistently smooth and reliable
11. How well do your current systems support a seamless customer experience?

1 – They create friction2 – They occasionally cause issues3 – Neutral or mixed4 – They mostly enable flow5 – They fully support seamless experience
12. How often are customer feedback and operational data used to improve service delivery?

1 – Rarely2 – Occasionally3 – Sometimes4 – Often5 – Continuously
13. How empowered are frontline teams to resolve issues and improve service?

1 – Not empowered at all2 – Rarely empowered3 – Somewhat empowered4 – Mostly empowered5 – Fully empowered
14. What are the biggest current obstacles to delivering a reliable, positive customer experience? (Select all that apply)

Process gapsSystem limitationsSiloed teamsLack of dataOther
15. Do your teams have clear ownership for each step of the customer journey?

1 – Not at all2 – Somewhat unclear3 – Mixed clarity4 – Mostly clear5 – Yes, very clear
16. How aligned are leadership, ops, and CX on what success looks like for the customer? (1–10 scale)

1 – Misaligned3 – Partially aligned5 – Moderately aligned7 – Mostly aligned10 – Fully aligned
17. How confident are you in your ability to scale service quality as you grow? (1–10 scale)

1 – Not confident3 – Low confidence5 – Neutral7 – Mostly confident10 – Very confident
18. What part of the customer experience is currently most painful or broken?
19. What’s working well in your current approach to customer experience?
20. If you could fix one thing that would have the biggest impact, what would it be?
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Customer Excellence (CX) Maturity Self-Assessment