Charles Lawrence Allen

Survey

How did you hear about Charles? (select) Insurance company His website A friend Magazine article Web search A Colleague

How pleasant was the waiting room area Extremely Very Some what Not very Not at all

How pleasant was the office setting Extremely Very Some what Not very Not at all

How well did the office staff do their job Extremely Very Some what Not very Not at all

Was the fee fair and reasonable Extremely Very Some what Not very Not at all

Was Charles’ behavior appropriate Extremely Very Some what Not very Not at all

How well did Charles know what he was doing Extremely Very Some what Not very Not at all

How confident are you that Charles will be able to help you Extremely Very Some what Not very Not at all

How well did the therapy experience met your needs Extremely Very Some what Not very Not at all

How confident are you about recommending Charles to a friend or relative Extremely Very Some what Not very Not at all

How likely is it that you will continue to meet with Charles on a regular basis Extremely Very Some what Not very Not at all

How likely is it that you will meet with Charles on an as needed basis Extremely Very Some what Not very Not at all

How sure are you that you would return to Charles in the future if you need additional therapy services Extremely Very Some what Not very Not at all

I would like Charles contact me through email for follow-up purposes in the future. (if yes, submit email address below in comments box)  Yes No

Suggestions for Charles / Additional comments:

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