Survey Form V10

Author: Colorlib

Released: September 2026

License: CC BY 3.0

A small dark feedback card that sits in the corner of a checkout page and asks what stopped the visitor today. Reasons are toggle chips backed by checkboxes, with an optional note, and at least one of the two is needed to send. It opens when the pointer leaves through the top of the window or from a demo button, closes with Esc or the close buttons, and returns focus to where it came from.

It is plain HTML and CSS plus a few lines of vanilla JavaScript: no jQuery, no Bootstrap files, no plugins, and the download is 7 KB. Use it on its own, or drop it into a Bootstrap 4, 5 or 6 project and it looks the same.

• Exit intent detected from the pointer leaving the top edge
• Non-modal card: no focus trap, Esc and close buttons dismiss it
• Reason chips are real checkboxes with a checked tick
• Needs a reason or a note, with a polite error message
• Focus returns to the trigger after closing
• Thank-you state with a saved-cart note and code