What is your email address?
*What percent improvement did you experience with treatment?
*How soon were you able to make your first appointment?
 
Very
Good		 Good Average Below
Average
*The courtesy you experienced with our front office staff was?




*Ease of scheduling?




*The courtesy of our clinical staff was?




*Explanation of your problem and how your therapist planned to help you?




*Respect for my confidentiality/privacy?




*Cleanliness?




*Overall Quality of Care and Service?




What did we do well with your care?
What could we have done better?
*Would you use us again?


*Would you recommend us to a friend?


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* denotes required field