Lakewood Laser & Skin Renewal | Lakewood CO
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Your comments are much appreciated.  Please complete the following survey. In appreciation for your comments, we will enter your name in a
monthly drawing for a Mineral Makeup Kit.

PLEASE RATE THE FOLLOWING ON A SCALE OF 1 - 5
Please select the appropriate number (1 = inadequate, 5 = beyond expectations):

The Consultation Session

1 2 3 4 5

Physician Input

1 2 3 4 5

Treatment Process

1 2 3 4 5

Information, education provided to Client

1 2 3 4 5

Reception

1 2 3 4 5

Clinical Atmosphere

1 2 3 4 5

How can we improve? (Please comment on items scored 3 or below)

Please comment about the outcomes of your treatments:

What additional services/products should we provide?

Additional comments:

First Name*

Last Name*

Email Address

Phone Number (so that we may contact you if you win the drawing)*

Please enter the phrase above

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