Welcome to Ipersonal Customer Satisfaction Survey

We value your feedback and appreciate you taking the time to complete our survey

Estimated time: 1 minute

1. How did you feel about your clinical experience? *

	5	4	3	2	1
Felt Safe	Felt Safe 5	Felt Safe 4	Felt Safe 3	Felt Safe 2	Felt Safe 1
Felt Respected	Felt Respected 5	Felt Respected 4	Felt Respected 3	Felt Respected 2	Felt Respected 1
Felt Valued	Felt Valued 5	Felt Valued 4	Felt Valued 3	Felt Valued 2	Felt Valued 1
Felt Confident	Felt Confident 5	Felt Confident 4	Felt Confident 3	Felt Confident 2	Felt Confident 1
Felt Enlightened	Felt Enlightened 5	Felt Enlightened 4	Felt Enlightened 3	Felt Enlightened 2	Felt Enlightened 1
Felt Understood	Felt Understood 5	Felt Understood 4	Felt Understood 3	Felt Understood 2	Felt Understood 1
Understood the Diagnostic and Treatment Plan	Understood the Diagnostic and Treatment Plan 5	Understood the Diagnostic and Treatment Plan 4	Understood the Diagnostic and Treatment Plan 3	Understood the Diagnostic and Treatment Plan 2	Understood the Diagnostic and Treatment Plan 1

(*) This field is required. Highest Score is 5 and lowest Score is 1

2. How would you evaluate our clinic in terms of: *

(*) This field is required. Highest Score is 5 and lowest Score is 1

3. How likely are you to recommend your Therapist to a friend or colleague?

Please rate only the therapists you interacted with. (*) This field is required. Highest Score is 10 and lowest Score is 1

Not at all Likely Extremely Likely
0	1	2	3	4	5	6	7	8	9	10

4. How likely are you to recommend Ipersonal to a friend or colleague?

(*) This field is required.

5. Is there anything that we could have done to improve the service you received?

(*) This field is optional.