YOUR HEALTH Wellness Centre Feedback
Thank you for taking the time to let us know about your experience with us!
General Information
1. Your name (optional)
Your answer
2. Is this your first visit to YOUR HEALTH Wellness Centre?
3. Why did you choose YOUR HEALTH? (Please select all that apply):
Treatment Experience
4. What service(s) have you received? (Please select all that apply):
5. Who was/were your therapists or doctors?
Your answer
6. Please rate your level of satisfaction with YOUR HEALTH performance in the following:
Strongly Disagree
Strongly Agree
Receptionist was courteous and professional
I was able to get an appointment when I wanted
Treatment cost was reasonable
tment goals were explained
Treatment was effective
Therapist/Doctor was knowledgeable about my condition
Therapist/Doctor was courteous and professional
Therapist/Doctor was on time for my appointment
My privacy was respected
7. If you stopped coming to YOUR HEALTH prior to your scheduled completion date, please indicate why:
Overall Impressions
8. Please select the statement that you feel best describes YOUR HEALTH:
Strongly Disagree
Strongly Agree
Has a well organized clinic
Has clean facilities and treatment areas
Provides a caring and friendly environment
Provides personalized treatment
Meets my needs
Provides high quality service
9. Do you believe that you are well informed about YOUR HEALTH’s services and products?
10. Would you recommend YOUR HEALTH to a friend or family member?
11. What do you like most about YOUR HEALTH?
Your answer
12. What would you like to see improved at YOUR HEALTH?
Your answer
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