Post Appointment Survey Please enable JavaScript in your browser to complete this form.Therapist Name *Kristin BellKristen DundeeJill ObbagyBrenna PanerasAndrea PriceWould you like us to follow up with you? *YesNoName (Optional. Only required if you would like us to follow up with you)FirstLastEmail (optional. Only required if you would like us to follow up with you)Phone Number (optional. Only required if you would like us to follow up with you)I felt respected and understoodNone to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)N/AI was honest with my therapistNone to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)N/AI agreed with my therapist's adviceNone to very little (0-24%)Somewhat ( 25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)N/AI followed my therapist's recommendationsNone to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)N/AMy therapist seemed uncaringNone to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)N/AMy therapist seemed aloof and distantNone to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)N/AMy therapist did not offer feedback or recommendationsNone to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)N/AThis meeting helped meNone to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)N/AThis meeting seemed to make things worseNone to very little (0-24%)Somewhat (25-50%)More than not (51-74%)A lot (75-90%)Entirely (91-100%)N/AOther (Please specify)Please rate the professionalism of the officeExcellentGoodFairPoorN/APlease rate the billing and financingExcellentGoodFairPoorN/APlease rate your time spent waiting in lobbyExcellentGoodFairPoorN/AOther (Please specify)If you have a complaint, please answer the following question: Check one box which describes your complaintSeriousUrgentNot urgent but importantFor your information onlyPlease explain your complaint(s) below. Thank youNameSubmit
