Client Survey

To help us serve you better, please take a moment to fill out this quick survey.

You will receive a complimentary facial or low level laser therapy session.

We appreciate your feedback!

Survey Form

Name:

Email Address:

Birth Month/Day:

Phone Number: - (optional)

1.	How would you rate the staff at PILC?
2.	Would you recommend this facility and its staff to your family and friends?
3.	Was the person who scheduled your appointment courteous and helpful?
4.	How would you rate the wait from time of check in until you saw the doctor?
5.	When you had your consultation were your questions answered to your satisfaction giving you a good understanding of your condition and treatment options?

Answer the following questions if you had a procedure done:

6.	During your procedure was the staff pleasant and courteous?
7.	How would you rate your overall procedure: comfortable, pleasant and to your satisfaction?
8.	How would you rate the professionalism and competence of the staff who worked on your procedure?
9.	After your procedure, did you have a good understanding of your post-op instructions?
10.	Were your post operative concerns addressed in a caring and timely matter?

Please list any areas in which our service could be improved:

Please share any additional comments: