How would you rate our clinic
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Not good
Excellent
1 is Not good, 10 is Excellent
Did your expectations of therapy match the experience
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Not at all
Yes, very much
1 is Not at all, 10 is Yes, very much
Did we meet your treatment needs?
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10
None of my needs have been met
All my needs have been met
1 is None of my needs have been met, 10 is All my needs have been met
Did you feel understood by your therapist?
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Not at all
Yes, Definitely
1 is Not at all, 10 is Yes, Definitely
Did you receive the outcomes you wanted?
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Not at all
Yes, Definitely
1 is Not at all, 10 is Yes, Definitely
How would you rate our administrative team?
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Terrible
Excellent
1 is Terrible, 10 is Excellent
If you were unhappy with the administration team, can you please let us know why and what we could do better?
If you required support again, would you reconnect with our clinic?
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No
Yes of course
1 is No, 10 is Yes of course
If you would not reconnect with our clinic, can you please let us know why?
Would you recommend our clinic to a friends or family?
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No
Yes of course
1 is No, 10 is Yes of course
If you wouldn't recommend us to friends and family, can you please tell us why?
Phone Number
Format: (000) 000-0000.
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*
First Name
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