* 1. The front office staff was courteous and helpful during check in and check out.

* 2. Your therapist listened and addressed your main concerns during counseling.

* 3. Please rank your overall experience with Genesis.

* 4. How likely are you to refer a friend to Genesis?

* 5. Please list any areas for improvement; i.e., ease of scheduling, billing, therapy, customer service, etc.

* 6. Thank you for your referrals and helping us provide even greater client care!