One-to-One & Pop-up Care Work Feedback Form
Thank you for taking the time to provide your honest feedback! I am always looking for ways to improve and your comments help me do so.
How satisfied were you with your time spent either at a one-to-one or pop-up?
Not Much
1
2
3
4
Very
5
1 is Not Much, 5 is Very
How grounded did you feel were you during your time receiving care work?
Not Much
1
2
3
4
Very
5
1 is Not Much, 5 is Very
My goal/topic was acknowledged and addressed
Disagree
1
2
3
4
Agree
5
1 is Disagree, 5 is Agree
What aspects could be improved?
What was/were your favorite part(s)?
How did this measure up to your expectations?
Knowing you'll continue to see results over the next few days, what results have you experienced already?
Would you book another session with me?
Yes!
No thanks
Maybe
Would you recommend to a friend?
Yes!
No
Maybe
Let's hear your testimonial!
Can I share any of your responses for marketing purposes? (Note: your name and identifying information will be redacted)
Go for it!
No thanks
Would you like me to follow-up via email in regards to your responses?
Yes
No
Name (Optional)
First Name
Last Name
Submit
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