Customer Feedback Survey Form #1

Feedback Survey
Thank you for choosing Health in Mind. To help us provide our valued clients with the best experience, we would appreciate your feedback with the short survey below:
Name

First NameLast Name
1. On a scale of 1 to 5, how do you rate your practitioner?

1

2

3

4

5

1 is Worst, 5 is Best
2. On a scale of 1 to 5, how do you rate your experience with our administration team?

1

2

3

4

5

1 is Worst, 5 is Best
3. On a scale of 1 to 5, how do you rate your Health in Mind experience?

1

2

3

4

5

1 is Worst, 5 is Best
What did we do well and what could we do better?
If you would like someone to contact you regarding your feedback, please enter your email below:
example@example.com
Thank you for completing our survey. Your feedback is really important to us and we appreciate you sharing your thoughts.

www.healthmind.com.au

ph: (08) 6183 1908 | hello@healthmind.com.au | HealthLink ID: hthimind

Level 1, 206 Stirling Hwy, Claremont WA 6010
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