Fitness Center Member Discharge Feedback Form
We value your feedback. Please help us improve by sharing your experience as you conclude your membership.
Member Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Membership Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Membership End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Primary Reason for Leaving
*
Relocation
Financial Reasons
Health Issues
Dissatisfaction with Facilities/Services
Lack of Time
Joined Another Fitness Center
Other
Please rate your satisfaction with the following aspects of our fitness center:
*
Rows
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Facilities & Equipment
1
2
3
4
5
Cleanliness
6
7
8
9
10
Group Classes & Programs
11
12
13
14
15
Staff Professionalism
16
17
18
19
20
Value for Money
21
22
23
24
25
Which facilities or services did you use most frequently? (Select all that apply)
Cardio Area
Weight Training Area
Swimming Pool
Group Classes
Personal Training
Sauna/Steam Room
Other
Would you recommend our fitness center to others?
*
Yes
No
Maybe
What could we have done to improve your experience?
Additional comments or suggestions
Signature (Please sign to confirm your feedback)
*
Submit Feedback
Submit Feedback
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