Nutrition Therapy Related Links Overview Feedback Feedback - Spanish Feedback - Vietnamese Feedback - Chinese Nutrition & Food Services Nutrition Therapy Survey 1) Who did you receive services from? Inpatient Dietitian (during your hospital stay) Outpatient Dietitian (for a clinic appointment) Appointment date (optional): Dietitian’s name (optional): 2) How satisfied were you with the nutrition services that were provided to you? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied 3) How useful was the nutrition information that was provided to you? Not at all usefulExtremely useful 1 2 3 4 5 6 7 8 9 10 4) Was the Dietitian knowledgeable? Not at all knowledgeableExtremely knowledgeable 1 2 3 4 5 6 7 8 9 10 5) Was the Dietitian able to answer all your questions? Yes No 6) How happy are you with the Dietitian's education, explanation, and/or recommendations? Not at all happyExtremely happy 1 2 3 4 5 6 7 8 9 10 7) Do you plan on making any changes after this appointment? Yes No If Yes, please describe: 8) How likely are you to recommend our Nutrition services to your families and friends? Extremely likely Very likely Somewhat likely Not so likely Not at all likely 9) Comments: (optional) Name (optional): Email (optional): Leave this field blank
1) Who did you receive services from? Inpatient Dietitian (during your hospital stay) Outpatient Dietitian (for a clinic appointment) Appointment date (optional): Dietitian’s name (optional): 2) How satisfied were you with the nutrition services that were provided to you? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied 3) How useful was the nutrition information that was provided to you? Not at all usefulExtremely useful 1 2 3 4 5 6 7 8 9 10 4) Was the Dietitian knowledgeable? Not at all knowledgeableExtremely knowledgeable 1 2 3 4 5 6 7 8 9 10 5) Was the Dietitian able to answer all your questions? Yes No 6) How happy are you with the Dietitian's education, explanation, and/or recommendations? Not at all happyExtremely happy 1 2 3 4 5 6 7 8 9 10 7) Do you plan on making any changes after this appointment? Yes No If Yes, please describe: 8) How likely are you to recommend our Nutrition services to your families and friends? Extremely likely Very likely Somewhat likely Not so likely Not at all likely 9) Comments: (optional) Name (optional): Email (optional): Leave this field blank
