Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Student Information First Name *Last Name *Email *Phone * Session Information Date of Systems Reset™: *Systems Health® Educator Name: *Session Type *New studentFollow-upConsultationInternshipWelcome Your feedback is valuable in helping improve our approach to ensure we're providing the best education possible. All responses are confidential and will be used solely for quality improvement purposes. Part 1: Before Your Systems Reset™ How easy was it to schedule your appointment? *Very difficultDifficultNeutralEasyVery easyHow easy was it to read the email directions? *Very difficultDifficultNeutralEasyVery easyHow long did you wait for the Systems Health Educator to start your session? *Less than 5 minutes5-15 minutes16-30 minutesGreater 30 minutesPart 2: Your Systems Health® Educator Did the Educator make you feel comfortable discussing your health concerns? *Not at allSomewhatModeratelyVery muchAbsolutely yesDid the Educator explain things in a way you could understand? *Not at allSomewhatModeratelyVery muchAbsolutely yesPart 3: The Systems Reset™ Interaction The Educator appropriately responded to your questions/concerns. *Not at allSomewhatModeratelyVery muchAbsolutely yesThe Educator asked about my lifestyle inputs (diet, exercise, etc) *Not at allSomewhatModeratelyVery muchAbsolutely yesThe questions asked were appropriate for my specific needs *Not at allSomewhatModeratelyVery muchAbsolutely yesDid you feel comfortable during the session? *Not at allSomewhatModeratelyVery muchAbsolutely yesPart 4: Your Personalized Plan Did the Educator explain your Natural Systems State? *Not at allSomewhatModeratelyVery muchAbsolutely yesDid the Educator explain your Current Systems State? *Not at allSomewhatModeratelyVery muchAbsolutely yesDo you understand the next steps in your recommended plan? *Not at allSomewhatModeratelyVery muchAbsolutely yesDo you need help implementing your personalized plan? *Not at allSomewhatModeratelyVery muchAbsolutely yesPart 5: Overall Experience How would you rate your overall experience with this Systems Health® Educator? *PoorFairGoodVery goodExcellentWould you recommend this Systems Health® Educator to friends or family? *Definitely notProbably notUnsureProbably yesDefinitely yesSubmit
