Client Feedback Form

Please help us to improve your experience by giving us your feedback.

Your Name (required)

Your Email (required)

Best number to reach you at (required)

Your therapist was
Nicki CookeJason MaxworthyLisa BarnesColin ParishSteve Cooke

Did your Therapist discuss your requirements and clarify what would occur?
YesNoI'm not sureN/A

Did the Therapist work on the areas you requested?
YesNoN/A

Did you feel comfortable to ask for a change of pressure?
YesNoN/A

Was the temperature of the room acceptable?
YesNo, it was too coldNo, it was too warmN/A

Was the Therapist clear in explaining the treatment they were undertaking?
YesNoN/A

How did this treatment compare with other professional treatments you have had?
BetterSameWorseN/A

Would you recommend this Therapist to a friend?
YesNoN/A

Are you satisfied with the outcome of your treatment?
YesNoN/A

How would you rate your overall experience (1-5,5 is best)
12345

Would you like to be contacted about your feedback?
YesNo

What was your impression of the facilities provided?

Were your expectations met by the therapist, the office staff, and the facilities?

Is there anything that could be done to improve your experience?

Is it okay to use your comments as a testimonial in our marketing materials?
Yes, but only use my first name & the first letter of last name (e.g. John C.)Yes, you may use both my first & last name (e.g. John Citizen)No, do not use my comments, thanks

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