Leave a Review for Healthspan Neurology

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for taking a few minutes to share your feedback. Taking a few moments to share your feedback helps me continue to learn, grow, and provide the most thoughtful, individualized care possible.

What type of visit did you last have with Dr. Gajaweera? *

Dementia Preventive Program

Neurologic Consultation

Mind Over Menopause

What aspects of your visit were most helpful?

Is there anything that could have improved your experience?

If our work together has been insightful and helpful, I’d greatly appreciate you taking a moment to write a brief anonymous testimonial for my website.

How would you describe your overall experience? *

Does Healthspan Neurology have permission to use an excerpt of your testimonial along with your initials and age on our website testimonial page? *

yes

Rating only, do not include comments, okay to leave initials and age

Rating only, do not include comments or initials and age

Required

Is there anything else you'd like to share with me?

Thank you so much for taking the time to respond. Your feedback is very important to me. If your experience was positive, please also consider writing a Google review using this link:

Google Review for Dr. G

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Healthspan Neurology, PC.

Does this form look suspicious? Report

Forms