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Customer Survey
Please take a moment to complete this form to help us improve our services.
Name ( Optional ):
Date:
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What type of therapy did you receive?:
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Acupuncture
Chiropractic
Nutritional
Kinesiological
Massage
Occupational
Physiotherapy
Traditional Chinese Medicine
Your Practitioner
How did you feel about your practitioner?:
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2
3
4
5
a. Approachable
b. Organized
c. Openness
d. Sincerity
e. Flexible in changing appointments
f. Information
Comments:
The Program
How did you feel about the following aspects of the techniques?:
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5
a. Personal attention
b. Variety of techniques (if applicable)
c. Variety of equipments (if applicable)
d. Confidence of the Practitioner
e. Overall satisfaction
Comments:
What did you like the most about your time at Mountainview Wellness Centre?:
What did you like the least? :
Is there one thing you would change about your experience at the Mountainview Wellness Centre? If so, what would it be and why?:
Additional comments or suggestions:
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Therapy of Interest:
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