Nutrition Support Clinic - Client Feedback Form
Feedback and refinement are essential to this practice. We greatly appreciate the time and effort you are putting in to provide us with your honest feedback.

If you do not agree with any of the below statements, please let us know how he can help to create a better environment for you or someone else in the future.

What is your full name?
(Leave blank if you would like your feedback to remain anonymous.)
Your answer
I felt supported. *
Strongly Disagree
Strongly Agree
I would recommend Nutrition Support Clinic to others. *
Strongly Disagree
Strongly Agree
Visiting Nutrition Support Clinic was worthwhile. *
Strongly Disagree
Strongly Agree
My needs were addressed in a timely fashion (e.g. follow-up on inquiries within 3 business days). *
Strongly Disagree
Strongly Agree
Please explain any of the above feedback and/or provide suggestions on how we can improve.
Your answer
Any positive feedback on what you especially appreciated about Nutrition Support Clinic or what we should continue doing?
Your answer
Do we have your permission to use positive feedback in the form of a testimonial? *
If yes, please provide your email in the next question.
If you would like someone to follow-up with you about your feedback, please provide the best email or phone number to reach you.
Your answer
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