Exit Survey

* Name:

* Email Address:

* Which service did you sign up for?

Neurology 101 (for athletes)

Neurology 101 Intensive Coaching

Functional Diagnostic Nutrition

Personal Training

Other

* Was you desired outcome or goal accomplished? If yes, or no, please describe

How would you rate the following:

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
* Your Coach clearly understood what was important to you, your goals and your desired outcome

* You felt that your Coach cared about you, your progress, your desired outcome and your experience with us

* You understood what exercises you were expected to do on your own, how often, how to and when to do them

* You felt confident doing the exercises on your own ("homework")

* You felt expectations for "Homework" were reasonable

* You knew HOW the exercises assigned to you would help you achieve your goals or desired outcome

* You made progress towards your goals or desired outcome

* You achieve your desired outcome or goal

* You identified that you achieved your goals or desired outcome with the help of Brain Based Fitness

* You were treated with respect during each interaction with the Brain Based Fitness team

Is there anything we can do to improve our services, offerings, business model or pricing?

What do you feel we did do that contributed to your success?

Are you willing to to refer us to a friend?

Willing to Refer

Not Yet

Is there anyone you know who may benefit from our services?

Yes

No

If so, would you be willing to ask them for their permission for us to contact them and invite them to a free consultation?

Yes

No