Cancellation Form Name * First Name Last Name Email * 1. Please select an option that best describes your reason for cancelling your Focused Nutrition plan? * Too Expensive (Financial Reasons) Not Effective (Dissatisfied with Results) Poor Service 2. How well did Focused Nutrition staff attend to your nutrition goals? * Extremely Well Very Well Moderately Well Slightly Well Not Very Well 3. How would you describe your overall satisfaction with Focused Nutrition? * Extremely Satisfied Very Satisfied Moderately Satisfied Slightly Satisfied Not Satisfied 4. How likely are you to recommend a friend or family member to Focused Nutrition? * Highly Likely Likely Not Very Likely 5. Did you achieve the goals you desired when starting with Focused Nutrition? * Yes To some extent No 6. Please give us some feedback on your experience with Focused Nutrition and how we could improve the service. * 7. As per the terms and conditions of this membership, I understand that my non-refundable membership renewal payment will be processed if this request is submitted less that 30-days before my renewal date. * Please tick to confirm Thank you!
