Instructions: We value your feedback. Please let us know how your experience has been by answering the following questions. Name & Surname: Contact Number: 1) The practitioner was prepared for my visits 1 Disagree 2 Neutral Disagree 3 Neutral 4 Agree 5 Strongly Agree 2) The practitioner understood myconcerns 1 Disagree 2 Neutral Disagree 3 Neutral 4 Agree 5 Strongly Agree 3) The practitioner gave me as much information as I wanted about what could do to manage my condition 1 Disagree 2 Neutral Disagree 3 Neutral 4 Agree 5 Strongly Agree 4) Therapy has helped me improve the quality of my life 1 Disagree 2 Neutral Disagree 3 Neutral 4 Agree 5 Strongly Agree 5) I was able to schedule appointments at times that suited me 1 Disagree 2 Neutral Disagree 3 Neutral 4 Agree 5 Strongly Agree 6) The information I received (materials,what staff/practitioners told me, etc.) was consistent 1 Disagree 2 Neutral Disagree 3 Neutral 4 Agree 5 Strongly Agree 7) The reception staff were friendly and helpful 1 Disagree 2 Neutral Disagree 3 Neutral 4 Agree 5 Strongly Agree 8) All things considered, I am satisfied with the service I received 1 Disagree 2 Neutral Disagree 3 Neutral 4 Agree 5 Strongly Agree Other areas of strength Suggestions for improvements Digital Consent Coco Vogue reserves the right to charge for appointments which has not been cancelled within 24 hours in advance. due to hazardous chemicals in the salon please make other arrangements for your children on appointment days. Coco Vogue will not be held laible for injury of accidents to or Date caused by unsupervised children. Send