Client Feedback Form
Rate us below. Your feedback is greatly appreciated.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Which location did you visit?
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Please Select
Clarksville, TN: 933 Tracy Lane, Suite D
Clarksville, TN: 1725 Wilma Rudolph Blvd., Suite H & I
Nashville, TN: 404 BNA Dr., Building 200, Suite 208
Who was your clinician/therapist?
*
How would you rate your experience with scheduling?
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1
2
3
4
5
How would you rate your confidence in your therapist's ability to help?
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1
2
3
4
5
How would you rate your overall experience with Imani Behavioral Health?
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1
2
3
4
5
Would you recommend Imani Behavioral Health to anyone else?
*
Please Select
Yes
No
Additional comments
How did you hear about us?
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Google
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Word of Mouth
In-Person
Other
Please verify that you are human.
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