Survey Thyroid Imbalance and Other Common Causes of Chronic Fatigue Please complete the short survey to better our company and provide our staff with feedback from our customers. 1. Have you seen any of our functional medicine providers?YesNoIf yes, how happy were you with their services? Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5If not, who did you see and what would have improved your experience?2. Have you met our staff? YesNoIf yes, were you greeted warmly and promptly? Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 53. Were your needs met efficiently and professionally?Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 54. Was our facility inviting? Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 55. Organized and clean? Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 56. Did you have a blood draw in our lab? YesNoPlease tell us what could have been better.Did your tech follow appropriate precautions? YesNo7. Was he/she professional? Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 58. Courteous?Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5Do you have any additional comments on how we can improve patient experience at Leaves of Life? 9. Would you like us to contact you? If so Please provide your name and phone number or email and we'll reach out. Thank you for your input!YesNoName *FirstLastPhoneEmail *EmailSubmit
