Patient Feedback Survey (McAllen)
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Date *
JJ
/
MM
/
YYYY
EMR # *
Therapy Type?  *
Obligatoire
How likely are you to recommend our clinic to your friends and family members? *
Not Likely
Very Likely
How satisfied are you by the overall care provided by your therapist?  *
Very Unsatisfied
Very Satisfied
How satisfied were you with the attentiveness shown towards your concerns?  *
Very Unsatisfied
Very Satisfied
How well were your evaluations and treatment plans explained?  *
Poorly
Very Well
Do you have any other recommendations or concerns?
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