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We value your feedback!
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What is your age?
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under 18 (Parent submitting form)
18-25
26-35
36-45
46-59
60-69
70+
Prefer Not to Disclose
If feedback is related to a class, what was your reason for attendance?
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Personal Development
Workplace Wellness
To Improve/ Better Manage Health
Stress Management
To Increase Physical Activity
Other
If Other, please specify.
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Class Name, Class Topic, or Name of Course Series:
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Date of Service or Class?
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Enter exact date or as close as you can remember.
Location of Service or Class?
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Facility location, Address or Name of Individual Host or Host Organization
Who was the Instructor, Coach or Trainer for Class or Service?
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Andrea "Andy"
Cynthia C.
Lisa H.
Karen R.
Silvia J.
Tasha O.
Can't Remember
Excellent? (check all that apply)
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Professional & Courteous
Well-Prepared
Encouraging/ Motivational
Attentive
Patient
Engaging, Smiles
Knowledgeable, Q&A
Not Applicable, No Opinion
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Good? (check all that apply)
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Professional & Courteous
Well-Prepared
Encouraging/ Motivational
Attentive
Patient
Engaging, Smiles
Knowledgeable, Q&A
Not Applicable, No Opinion
You may make more than 1 selection; check all that apply
Satisfactory? (check all that apply)
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Professional & Courteous
Well-Prepared
Engaging/ Motivational
Attentive
Patient
Engaging, Smiles
Knowledgeable, Q&A
Not Applicable, No Opinion
You may make more than 1 selection; check all that apply
Anything Below Expectations?
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Any additional comments you wish to share?
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It is not required for you to provide your contact information unless you want us to follow-up with you regarding any comments provided or you would like the Instructor/ Coach/ Trainer to know specifically who provided the feedback received.
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"There's nothing more important than our good health -
that's our principal capital asset.
-Arlen Specter
Home
FITNESS
Movement Lab Studio
Private Fitness Training
HEALTH COACHING
Workplace Wellness
CPR & First Aid Training
Blog
FAQ
General Q & A
Insurance Info
Patient Referrals
CONTACT INFO
Contact Us
About Us
