Exit-intent survey Template

The Exit-intent survey block combines a recognizable “Before you go” heading with a practical visitor-feedback form. Five radio options organize common improvement responses, while a comments textarea and email field support more detailed input and possible contact. The form occupies the left side of a split dialog, with a single portrait fashion image balancing it on the right. A black full-width Submit button creates a clear finishing point below the pale gray fields. The centered white rounded container and dark translucent backdrop give this block a distinct modal-style presentation for a focused interaction.
ID : 6548891   |   Category : Fashion & Beauty, Modal Popup

A Centered Survey Design With Clear Visual Contrast

The section’s strongest design choice is the relationship between a compact left-side form and a single portrait image on the right. The “Before you go” heading establishes the purpose quickly, and the five radio options make the response structure visible without expanding the form into a long list of separate controls. The comments textarea and email input add depth to the interaction, allowing the visitor to provide both a selected reason and additional detail. A black full-width Submit button gives the lower part of the form a strong visual endpoint.

The visual treatment makes this option distinct from a conventional full-width contact section. Pale gray fields recede behind the dark button, while the white rounded dialog remains sharply separated from the dark translucent backdrop. The portrait image uses rounded corners and occupies enough space to balance the denser form column without adding another content group. The result is a contained survey composition with a clear focal order: message, choices, additional input, then submission.

Among ready-made block designs, this option fits projects that need a feedback interaction with more visual presence than a plain form. It can be selected when the section should feel like a deliberate closing prompt, while the surrounding page remains responsible for the rest of the content and navigation.

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Open this ready-made template in the Template Builder and customize it visually in the Nicepage editor. Replace demo content, edit page sections, and adapt the design to your project without rebuilding the template from scratch.

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1. Download and Install the Nicepage application for Windows and Mac. Or WordPress and Joomla plugins from the download page
2. Create a new page or select existing
3. Click Add new block, search for id 6548891 and click enter

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