Feedback Form

Type of Service*
Mental HealthSubstance Abuse DisorderDUI ClassesNARCAN Training
Type of Appointment*
In-PersonTelehealth
1. How satisfied were you with your overall experience in a scale of 1-5?*
1 Very Unsatisfied23 Neither Satified nor unsatisfied45 Very Satisfied
2. What did we do well?*

3. What could we improve?*

4. Would you recommend our clinic to others?*
YesNo
5. May we use your comments as a testimonial?
Yes, I give my permission to use my feedback
6. (optional) Your name

(optional) Your email