Reflection and Feedback Questionnaire

TWJ Reflection and Feedback Questionnaire

I am always striving to improve the way I do things to better serve my clients. With your package nearing the end, I would really appreciate your honest reflection and feedback by completing this form for me. I have really enjoyed working with you and feel very grateful to have had the opportunity to get to know you and also to support you along your journey to wellness. There is definitely scope to continue working together if you wish to do so, but we can discuss this in your last session together. For now, please provide me with as much input as possible.

Name*
First Last
Date
MM slash DD slash YYYY
Email*
On a scale of 1 - 10 (10 being the best) how well did you feel start before starting the program?*
Please enter a number from 0 to 10.
On a scale of 1 - 10 (10 being the best) how well are you feeling now that you have finished the program?*
Please enter a number from 0 to 10.
What has changed for you since we first started working together?*
What have you learned through our work together?*
What areas of the program did you enjoy?*
What areas of the program did you not enjoy?*
Did the time period of this program work for you?*
- Perfect
- Too long
- Too short
What are you most proud of accomplishing since we started working together?*
Where do you feel that you could use additional support?*
On a scale of 1 - 10 (10 being the highest) how effective has this program been for you?*
Please enter a number from 0 to 10.
I would love to know if you have any suggestions for improving your experience in working with me. Please share additional things you would have found helpful that wasn't included in your package. Your feedback is very helpful 🙂*
Where would you like to go from here and what do you think needs to happen to get you there?*
Do you feel that your expectations on this investments was met?
- Yes
- No
Would you like to receive further information about packages to continue working together?*
- Yes
Would you recommend this program to anyone else?*
- Yes
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