Client Feedback Form
Date
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Day
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Month
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Your Name or initials
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First Name
Last Name
E-mail
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Did your therapist(s) explain the treatment(s) to you?
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Yes
No
Which treatment did you have?
Please rate your Therapist
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Average
Good
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Please rate your Therapist
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Average
Good
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Further information you'd like to add?
What other treatments would you like to see at The Elixir Clinic?
Would you come back again?
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Yes
No
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