Client Feedback Form

Client Feedback Form

Rate us below. Your feedback is greatly appreciated.
Full Name*

First NameLast Name
Email Address*
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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 your overall experience with Imani Behavioral Health?*
Would you recommend Imani Behavioral Health to anyone else?*
Additional comments
How did you hear about us?*

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