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