Your comments are much appreciated.  Please complete the following survey. In appreciation for your comments, we will enter your name in a monthly drawing for a Mineral Makeup Kit. PLEASE RATE THE FOLLOWING ON A SCALE OF 1 - 5 Please select the appropriate number (1 = inadequate, 5 = beyond expectations):

The Consultation Session 1 2 3 4 5 Physician Input 1 2 3 4 5 Treatment Process 1 2 3 4 5 Information, education provided to Client 1 2 3 4 5 Reception 1 2 3 4 5 Clinical Atmosphere 1 2 3 4 5 How can we improve? (Please comment on items scored 3 or below) Please comment about the outcomes of your treatments: What additional services/products should we provide? Additional comments: First Name* Last Name* Email Address Phone Number (so that we may contact you if you win the drawing)* Please enter the phrase as it is shown in the box above.