Client feedback form

A Little Nutrition counselling & coaching services is continually seeking to improve the quality of service offered by our team of registered dietitians. Since you have visited our service recently, we would like you to evaluate your experience with us.

Your input is very valuable.

This form has the option to be anonymous, and will be kept confidential within our company. The valuable information you provide will be used to improve our service.

1. My session with the dietitian helped me with the nutrition concern(s) that originally led me to seeking nutrition counseling/coaching at A Little Nutrition

Yes
No
Unsure

If you marked "No" or "Unsure", please explain why below:

If you marked "No" or "Unsure", would you like to have Susan, the owner of A Little Nutrition contact you to discuss any concerns?

Yes
No

2. Do you feel your dietitian had the knowledge/expertise to address your nutrition concerns and answer your nutrition related questions?

Yes
No

If you answered "No", did your dietitian put a plan in place to get you the information or care that you need?

Yes
No

3. Do you plan on continuing to work with your dietitian in regards to your nutrition related concern?

Yes
No
Unsure at this time

If you answered "No", please tell us why?

I didn’t feel the dietitian was the right fit for me
Too busy right now/ Not the right moment in time to be working on my nutrition
I was only interested in one appointment/ I got all of the information that I needed

4. As the owner of A Little Nutrition I am passionate about the nutrition care we deliver to our clients. If there is any feedback that you feel is pertinent to improving client care at A Little Nutrition I would really appreciate to hear from you. Please use this space to express your thoughts/concerns:

5. Please let us know what you loved about your appointment so we can continue these practices!

If you would like to leave your name, you can do so below.

First Last

If you have indicated that you would like Susan to contact you, please provide your name below and the best time for her to contact you. If not, please leave blank. All information provided is private and confidential.

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