Please take a few moments to fill out this feedback form and let us know how we did today.

Date of appointment: Month / Day / Year

 

With 1 being poor and 5 being excellent please rate the following:

1. How quickly you received an appointment?
1 2 3 4 5
         
2. The service at the reception desk?
1 2 3 4 5
         
3. The treatment by the therapist?
1 2 3 4 5
         
4. Your overall experience at the Centre?
1 2 3 4 5
         
5. Would you recommend us to others?
Yes No      

 

6. Any suggestions or comments?

 

7. Are you:
Staff Bison Athlete Student Community

 

Would you like us to follow up your comments? If so, please provide us with your contact information.

Name:

Phone:

E-mail: