Customer Survey

Please take a moment to complete this form to help us improve our services.

Name ( Optional ):

Date:

Your Practitioner

Comments:

The Program

How did you feel about the following aspects of the techniques?:

	1	2	3	4	5
a. Personal attention
b. Variety of techniques (if applicable)
c. Variety of equipments (if applicable)
d. Confidence of the Practitioner
e. Overall satisfaction

Comments:

What did you like the most about your time at Mountainview Health & Wellness Centre?:

What did you like the least? :

Is there one thing you would change about your experience at the Mountainview Health & Wellness Centre? If so, what would it be and why?:

Additional comments or suggestions:

	1	2	3	4	5
a. Approachable
b. Organized
c. Openness
d. Sincerity
e. Flexible in changing appointments
f. Information

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