Client Feedback Form

Client Feedback Form

Thank you for visiting Imani! We would love to hear your feedback! Please complete the short survey below. Here at Imani Behavioral Health, we want to provide the best customer service and therapy experience for the clients we serve. Your comments and suggestions about your therapy visits will help us evaluate our services and understand how we can improve our care. Thank you in advance for completing the survey.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Which location did you visit?*
Who was your clinician/therapist?
How would you rate your experience with scheduling?*
How would you rate your confidence in your therapist's ability to help?*
How would you rate our office cleanliness?*
How would you rate the friendliness of our staff?*
How would you rate your overall experience with Imani Behavioral Health?*
Would you recommend Imani Behavioral Health to anyone else?*
Additional comments or suggestions for improvement.
How did you hear about us?*

GoogleFacebookInstagramX (fka Twitter)LinkedInWord of MouthIn-PersonOther
Please verify that you are human.*
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