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1. Contact Information (Optional)
By providing your contact information you are entered in a drawing for a $50 gift card to Target, Best Buy, or Bed Bath & Beyond!

2. How did you hear about us?

4. Please rate the following:

Greeting you received each time you arrived.
Initial explanation of insurance, benefits, and billing by the front office staff.
Cleanliness of the facility.
Friendliness, hospitality, and comfort with your care providers.
Knowledge, understanding, education, and instruction given by your care provider.
Satisfaction with your clinical care and outcome of that care.
Experience with our billing process.
Interaction with our billing team.
Thank you you received at the end of each visit.

5. Did you receive reminder calls prior to scheduled appointments?

6. How likely are you to recommend us to family or friends?

7. If so inclined, please leave a note for your therapist:

*By submitting your statement you are authorizing us to share your feedback on our website. Thank you!

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