Dr. Arielle Rubin COMMUNUTY Survey Form

COMMUNITY Survey Form for Dr. Arielle Rubin

Thank you for taking the time to submit a survey about the Autism Roadmaps. Your feedback is instrumental in shaping experiences of future patients in the community, and I sincerely appreciate your thoughtful contribution. - Dr. Arielle Rubin
All About Your Experience
Name*

First NameLast Initial
Overall Community Experience: Please describe your general experience in the community so far.
Recommendation: What would you tell someone who is considering joining the Community?
Most Useful Topics/Sessions: Please describe the sections of the community you find most useful and why.
Application: If able, please share any examples of how you have or will apply what you learned in this community in your Autism and/or mental health parenting approach.
Desired Additional Content: Which topic(s) would you have liked additional or follow-up content for?
Suggestions for Improvement: Anything we could be doing differently, add to future webinars to make it even more helpful?
May we share your First name in a testimonial publicly?

Yes, I am comfortable with my testimonial, along with my name (First Name only), being shared publicly.No, I would prefer that I my name not included in any public testimonial.
By clicking "Submit" you are agreeing to the following terms:

You agree that we may publish your testimonial publicly, if selected above, on Dr. Arielle Rubin's professional website [and on any successor professional website that she may operate], on social media pages, and marketing print materials. We will maintain anonymity unless you give permission otherwise to share your first name with testimonial. To ensure HIPAA compliance, we may need to make certain edits to your testimonial, such as removing any patient name's in any public testimonial. You further agree that we may edit the testimonial and publish edited or partial versions of the testimonial. However, we will never edit a testimonial in such a way as to create a misleading impression of your views.
E-Signature
Date

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Thank you for your time!
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COMMUNITY Survey Form for Dr. Arielle Rubin

All About Your Experience

By clicking "Submit" you are agreeing to the following terms:

Thank you for your time!