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Editorial from 417 Mag
PATIENT SURVEY
OUR STORE
FREE OFFER

Your satisfaction is very important.  I strive to provide professional services ensuring your appeasement. By filling out this survey, you will be providing feedback necessary to improve my services. I thank you for your time and wish you a wonderful day.
Please check the services provides
How satisfied were you with the services you received?
If you selected anything other than very satisfied, please explain 
Would you recommend my services?
If you selected anything other than yes, please explain
If you would like to provide a testimonty to post on this web site, either anonymously or using your first name and city (for your privacy), I would greatly appreciate it. (please use box provided below)
Your Name (optional)
email address
(optional)
contact number
(optional)
Any additional feedaback, comments, or suggestions:
Tell a friend about this page
Would you be willing to do a video testimony?
Would you be willing to provide an audio testimony using just your first name?
Add this page to your favorites.
Were your presenting issue(s) resolved to your satisfaction within the recommended amount of sessions?
If your answer was no, please check one
If your answer was other, please explain below
How many session(s) have you received?
Will you be returning for a future session? 
Thank you for filling out this survey
If so for which service?
MAYBE
NO
YES
NO
YES
NO
YES
Yes
No
Still receiving sessions