Feedback Questionnaire

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					Feedback Questionnaire

We continually modify the content of our programs to adjust to the needs of our clients. Please fill out the
following to help us in continuing to improve our programs. Thank you.

Please give us a sense of your interest in the program.
      Excited             Interested            Neutral          Not Interested               Awful
I’m going to act     I’m going to         I’m interested in   The information     No offense to Paul, he’s
on at least one      probably act on      what was said       in the program      a nice guy and all, but I
item if not all of   at least one item.   but I don’t think   doesn’t make        don’t get it.
the points made.                          it’s for me.        sense to me.

Rate the quality of the keynote/program.
      Excellent               Good                   Okay             Satisfactory               Awful

Rate the usefulness of the information in the keynote/program to you.
      Excellent               Good                   Okay             Satisfactory               Awful

What did you like best?
What interested you about the topic?
What ideas did you find most helpful?

What would you like to see improved
or removed from the program?
What would you have liked to hear more about
or included in the program?

Do you have any other comments?
May I quote you? Yes / No

Do you know anyone who could benefit
from our services? In what way?
How can we contact them?

Would you be interested in:
       Having Paul speak to you or your group on other topics.
       Participating in an e-Course (a course provided by email).
       Joining his newsletter – Food For Thought.
       Reading a book on this subject written by Paul

Participant Name
& Contact Information:

Igniting Your Success By Developing a Mindset for Peak Performance                   613.264.3791 [p]                                                                      613.264.0454 [f]

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