Patient Feedback

At Mental Fitness Clinic, we constantly are evolving to meet the needs of our patients. Your feedback is greatly appreciated and encouraged to facilitate improvements. Thank you for your participation.

You have the option of completing the patient survey or you can simply leave us a free-form comment at the bottom of this page under: “Any other general feedback for the clinic:”

Do not put your full name, or any sensitive identifying information such as dates of birth or medical information on this form as the transmission is not meant for this type of data.

Are you a current patient?

Were you satisfied with the front office administrative assistance?
YesNo

Please explain:

Was the administrative assistance polite and friendly?
YesNo

Please explain:

Were you able to easily contact the clinic by telephone?
YesNo

Please explain:

Did you feel satisfied with your experience with your clinician?
YesNo

Please explain:

Did you feel like there was enough time to explain your condition to your clinician on your visit?
YesNo

Please explain:

Would you recommend your clinician to another individual?
YesNo

Please explain:

Any other feedback about your experience with your clinician?
YesNo

Please explain:

Where you satisfied with your experience with our website?
YesNo

Please explain:

If you would like to be contacted about your feedback please provide a unique phrase in the box so that we can identify your survey, and call our clinic to discuss with us at your convenience (optional):

Any other general feedback for the clinic: