Consultation Feedback Form

Thank you for taking the time to fill this out — your feedback helps me learn and grow as a consultant!

Name

First Name

Last Name

Email Address

Rate your overall satisfaction in working with me:

(Scale of 1-10, 1 being poor, 10 being excellent)

Satisfaction with helping you set stretching, yet achievable goals:

(Scale of 1-10, 1 being poor, 10 being excellent)

Satisfaction with helping you to increase your self-awareness:

(Scale of 1-10, 1 being poor, 10 being excellent)

Satisfaction with helping you to feel empowered to reach goals:

(Scale of 1-10, 1 being poor, 10 being excellent)

How did working with me benefit your life/relationships/work, etc.?

Did you achieve the goals/results you were looking for from the consultation experience? How so or not?

What would you have changed to make our working together even more effective for you?

Is there any other feedback that you would like to give?

May I use your feedback in client testimonials? (If so, please answer the following question, as well)

Yes, you may!

I'd prefer you didn't.

How would you prefer I cite your feedback if used?