Please enable JavaScript in your browser to complete this form.Name (OPTIONAL)FirstLast1. Your Therapist *MAKE YOUR SELECTIONDr. Michael CornwallDr. Dasa JendrusakovaNot Applicable2. Number of Visits *MAKE YOUR SELECTION1-34-66-11Not Applicable4. Appointment availability (within 5 business days of your request)MAKE YOUR SELECTIONExecellentGoodPoorNot applicable3. The Online Scheduling OptionMAKE YOUR SELECTIONExcellentGoodPoorNot applicable5. The Online Intake Form Option MAKE YOUR SELECTIONExcellentGoodPoorNot Applicable6. Hours of operation (10:00 a.m. to 6:30 p.m.)MAKE YOUR SELECTIONExcellentGoodPoorNot Applicable7. Ease of making an appointmentMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable8. Keeping you informed of your appointment time MAKE YOUR SELECTIONExcellentGoodPoorNot Applicable9. Ease of using driving directions and signage MAKE YOUR SELECTIONExcellentGoodPoorNot Applicable10. Ease of parkingMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable11. Ease of building accessibility MAKE YOUR SELECTIONExcellentGoodPoorNot Applicable13. Waiting time in the reception areaMAKE YOUR SELECTIONExcellentGoodNot Applicable14. Ease of check-inMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable12. Ease of using public transportation MAKE YOUR SELECTIONExcellentGoodPoorNot Applicable13. Overall Comfort (restrooms, drinking water, comfort of furniture, temperature, etc)MAKE YOUR SELECTIONExcellentGoodPoorNot Applicable14. Ease of contacting us after hours (phone, text and email) (within 24 hours)MAKE YOUR SELECTIONExcellentGoodPoorNot Applicable15. The professionalism of your therapistMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable16. Therapist’s willingness to listen to you carefully and patientlyMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable17. You and your therapist had clearly established goalsMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable18. Therapist’s ability to clearly explain the strategy used to achieve your goalsMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable19. Effectiveness of therapy strategyMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable20. Your Treatment Plan was provided upon requestMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable21. Time was taken to answer your questions completely MAKE YOUR SELECTIONExcellentGoodPoorNot Applicable22. Adequate time was spent with you (45/60 minutes)MAKE YOUR SELECTIONExcellentGoodPoorNot Applicable23. Ease of getting an alternative or additional referral if you needed oneMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable24. Your ability to obtain a psychiatric referralMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable25. The overall quality of your careMAKE YOUR SELECTIONExcellentGoodPoorNot Applicable26. The likelihood you would recommend our practice to your friends and othersMAKE YOUR SELECTIONExcellentGoodPoorNot ApplicableIf there is anything you believe we can do to improve our services, please tell us about it.Email (Optional)Submit Your Responses