Nutritionsmarts.com

Patient Evaluation Of Nutrition Services

Thank you for visiting our nutrition office.  In order for us to continue improving nutritional services for our patients, we would like you to tell us how your experience was.  This is very important to us because without honest feedback we cannot make effective changes.  Please complete the short questionnaire below.  We sincerely appreciate your assistance.  Your response will be given our thoughtful consideration.

Did the scheduling of your appointment go smoothly? *

Select OneYesNo

Was the counseling environment comfortable? *

Select OneYesNo

Was the nutrition information provided in a clear and easy to understand? *

Select OneYesNo

Did you have enough time during your consult to ask questions? *

Select OneYesNo

Did you feel comfortable enough during your consult to ask questions? *

Select OneYesNo

Was the information “too little”, “just enough”, or “too much” *

Select OneYesNo

Did you read the nutrition information provided to you in your consult after you left the office? *

Select OneYesNo

If “Yes”, was it “easy to understand” or “difficult to understand”? *

Select OneYesNo

Are you planning to return for follow-up visits? *

Select OneYesNo

Would you recommend our services to your friends or family? *

Select OneYesNo

If you have answered “No” to any of the questions, please share with us why. Also, please feel free to add any suggestions or other observations.

OPTIONAL: Your Name

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