HEALUS CLIENT  SATISFACTION SURVEY Name: Phone: (With Area Code) Email: 5 = Very Good,  4 = Good,  3 = Average,  2 = Fair,  1 = Poor 5             4              3              2               1 Your overall first impression of us.......................................................... Please rate our facility in terms of appearance, comfort, etc............ Please rate our facility in terms of cleanliness, hygiene, etc............ How we answered the phone and greeted you in person................. How we set your appointment................................................................. How we explained our services to you................................................... The Staff’s level of courtesy and attentiveness..................................... The Practitioner’s level of courtesy and attentiveness........................ Starting & finishing on time...................................................................... Results from the services you received................................................. Financial transactions............................................................................... Follow up care and contact....................................................................... Yes No Were there any specific problems you had before, during or after your visit? If "Yes", please explain in space below: Are you or will you be using our services regularly? Yes No If "No", please explain in space below: Will you refer us to others? Yes No If "No", please explain in space below: How did you find out about us?: Other questions, comments, or feedback:

Dear Valued Client, Thank you for visiting the Healus Center during our first months in business. Our clinic is under new management. Lisa Starbird and Jude Gibson bring years of experience with client services to facilitate your future treatment, as we are expanding to include other essential services to improve the connections between your body and brain, such a neurofeedback, chiropractic, acupressure, acupuncture and individualized strength and conditioning training. Our desire is to provide you with quality, professional service and develop a better understanding of your needs and wants. To enable us to provide you with the best service, we are requesting few minutes of your time to complete the Online Survey below. Thank you for taking a few minutes to complete this survey--we will give your responses and comments our sincere attention, and look forward to continuing to be of service. Sincerely, Jocelyn Olivier Founder and President--Healus Neuro-Rehab Center, LLE

Thank You!

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HEALUS CLIENT  SATISFACTION SURVEY