Customer Satisfaction Survey

	Excellent	Good	Adequate	Poor	Unacceptable	N/A
Understanding your concerns	Understanding your concerns Excellent	Understanding your concerns Good	Understanding your concerns Adequate	Understanding your concerns Poor	Understanding your concerns Unacceptable	Understanding your concerns N/A
Communicating clearly and effectively	Communicating clearly and effectively Excellent	Communicating clearly and effectively Good	Communicating clearly and effectively Adequate	Communicating clearly and effectively Poor	Communicating clearly and effectively Unacceptable	Communicating clearly and effectively N/A
Keeping you motivated to continue your goals	Keeping you motivated to continue your goals Excellent	Keeping you motivated to continue your goals Good	Keeping you motivated to continue your goals Adequate	Keeping you motivated to continue your goals Poor	Keeping you motivated to continue your goals Unacceptable	Keeping you motivated to continue your goals N/A
Beginning & Ending appointments on time	Beginning & Ending appointments on time Excellent	Beginning & Ending appointments on time Good	Beginning & Ending appointments on time Adequate	Beginning & Ending appointments on time Poor	Beginning & Ending appointments on time Unacceptable	Beginning & Ending appointments on time N/A
Acted professionally	Acted professionally Excellent	Acted professionally Good	Acted professionally Adequate	Acted professionally Poor	Acted professionally Unacceptable	Acted professionally N/A
Feel we work well together	Feel we work well together Excellent	Feel we work well together Good	Feel we work well together Adequate	Feel we work well together Poor	Feel we work well together Unacceptable	Feel we work well together N/A
Help you to find solutions on your own	Help you to find solutions on your own Excellent	Help you to find solutions on your own Good	Help you to find solutions on your own Adequate	Help you to find solutions on your own Poor	Help you to find solutions on your own Unacceptable	Help you to find solutions on your own N/A
Feel safe to talk about your concerns	Feel safe to talk about your concerns Excellent	Feel safe to talk about your concerns Good	Feel safe to talk about your concerns Adequate	Feel safe to talk about your concerns Poor	Feel safe to talk about your concerns Unacceptable	Feel safe to talk about your concerns N/A
Satisfaction with your progress	Satisfaction with your progress Excellent	Satisfaction with your progress Good	Satisfaction with your progress Adequate	Satisfaction with your progress Poor	Satisfaction with your progress Unacceptable	Satisfaction with your progress N/A
I could do more to make nutritional counseling more useful	I could do more to make nutritional counseling more useful Excellent	I could do more to make nutritional counseling more useful Good	I could do more to make nutritional counseling more useful Adequate	I could do more to make nutritional counseling more useful Poor	I could do more to make nutritional counseling more useful Unacceptable	I could do more to make nutritional counseling more useful N/A

Excellent

Good

Adequate

Poor

Unacceptable

N/A

Understanding your concerns

Understanding your concerns Excellent

Understanding your concerns Good

Understanding your concerns Adequate

Understanding your concerns Poor

Understanding your concerns Unacceptable

Understanding your concerns N/A

Communicating clearly and effectively

Communicating clearly and effectively Excellent

Communicating clearly and effectively Good

Communicating clearly and effectively Adequate

Communicating clearly and effectively Poor

Communicating clearly and effectively Unacceptable

Communicating clearly and effectively N/A

Keeping you motivated to continue your goals

Keeping you motivated to continue your goals Excellent

Keeping you motivated to continue your goals Good

Keeping you motivated to continue your goals Adequate

Keeping you motivated to continue your goals Poor

Keeping you motivated to continue your goals Unacceptable

Keeping you motivated to continue your goals N/A

Beginning & Ending appointments on time

Beginning & Ending appointments on time Excellent

Beginning & Ending appointments on time Good

Beginning & Ending appointments on time Adequate

Beginning & Ending appointments on time Poor

Beginning & Ending appointments on time Unacceptable

Beginning & Ending appointments on time N/A

Acted professionally

Acted professionally Excellent

Acted professionally Good

Acted professionally Adequate

Acted professionally Poor

Acted professionally Unacceptable

Acted professionally N/A

Feel we work well together

Feel we work well together Excellent

Feel we work well together Good

Feel we work well together Adequate

Feel we work well together Poor

Feel we work well together Unacceptable

Feel we work well together N/A

Help you to find solutions on your own

Help you to find solutions on your own Excellent

Help you to find solutions on your own Good

Help you to find solutions on your own Adequate

Help you to find solutions on your own Poor

Help you to find solutions on your own Unacceptable

Help you to find solutions on your own N/A

Feel safe to talk about your concerns

Feel safe to talk about your concerns Excellent

Feel safe to talk about your concerns Good

Feel safe to talk about your concerns Adequate

Feel safe to talk about your concerns Poor

Feel safe to talk about your concerns Unacceptable

Feel safe to talk about your concerns N/A

Satisfaction with your progress

Satisfaction with your progress Excellent

Satisfaction with your progress Good

Satisfaction with your progress Adequate

Satisfaction with your progress Poor

Satisfaction with your progress Unacceptable

Satisfaction with your progress N/A

I could do more to make nutritional counseling more useful

I could do more to make nutritional counseling more useful Excellent

I could do more to make nutritional counseling more useful Good

I could do more to make nutritional counseling more useful Adequate

I could do more to make nutritional counseling more useful Poor

I could do more to make nutritional counseling more useful Unacceptable

I could do more to make nutritional counseling more useful N/A

Question Title

* 2. Overall, how likely are you to refer our services to a friend, colleague, or family member?

Excellent

Good

Maybe

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* 3. What has been the most beneficial tool, skill, or lesson that we have shared with you?

Question Title

* 4. What was something that exceeded your expectations of nutritional counseling?

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* 5. What was something that did not meet your expectations of nutritional counseling?

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* 6. Where would you rate your progress regarding the original reasons you began nutritional therapy?

Getting much better?

Getting better?

Staying at about the same level?

Getting worse?

Getting much worse?

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* 7. Based on our performance, how likely is it that you will use us in the future?

Certain

Very likely

Somewhat likely

Unlikely

Very unlikely

Customer Satisfaction Survey

How Are We Doing?

Question Title

* 1. Please rate the following aspects of our work.

Question Title

* 2. Overall, how likely are you to refer our services to a friend, colleague, or family member?

Question Title

* 3. What has been the most beneficial tool, skill, or lesson that we have shared with you?

Question Title

* 4. What was something that exceeded your expectations of nutritional counseling?

Question Title

* 5. What was something that did not meet your expectations of nutritional counseling?

Question Title

* 6. Where would you rate your progress regarding the original reasons you began nutritional therapy?

Question Title

* 7. Based on our performance, how likely is it that you will use us in the future?

Question Title

* 8. If you have any suggestions regarding how we could improve the services we provide to you, please enter them in the box below.