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:

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