Looks like this:
But what do you ask them? Well, there's an extra benefit with this one. You can actually use this info to improve your Web site. Perhaps you're wondering if your users enjoy using your frames, or whether you should break your pages up into smaller sections... now is the time to ask.
Take part in my survey
You'll need to use a "real" form script for this. This isn't an HTML tutorial so you'll have to find out how to set up a form for yourself, but there are some points to consider...
It will involve some effort by the user, it's not a "one click" tactic. Therefore, there must be something in it for them. In other words, they want to know the results. Always send them the results of the survey and tell them what date the results will arrive in their mailbox.
Here's an excellent resource on the subject of surveys: John Jensen's analysis.net