Rise TMS Patient Feedback

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Patient Feedback Form

Thank you for taking the time to provide your honest feedback! We are always looking for ways to improve and your comments help us do so.

6Questions

1
How satisfied were you with your treatment at Rise TMS?
1
2
3
4
5
Not Much
Very
2
How would you rate interactions with the Rise TMS staff?
1
2
3
4
5
Worst
Best
3
How likely are you to recommend TMS treatment to others?
1
2
3
4
5
Not likely at all
Very likely
4
Please feel free to share your experience at Rise TMS:
5
Can we share your response?* This field is required.
Go for it!
No thanks
6
Name and Date of Birth* This field is required.For internal records only
Full Name (First Last)
Date of Birth
Should be Empty:

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