Patient's Name

First Name

Last Name

1. On a scale of 0 to 5, how would you rate your experience at RENUE Medical Centre? *

0 – Very dissatisfied: did not meet expectations in any aspect.

1 – Dissatisfied: several important aspects were unsatisfactory.

2 – Fair: but with relevant shortcomings or issues.

3 – Satisfied: met expectations in most aspects.

4 – Very satisfied: exceeded expectations in several aspects.

5 – Excellent: greatly exceeded expectations in all aspects.

2. On a scale from 0 to 5, how noticeable your symptoms had decrease during this first 30 days after receiving treatments? *

0 – Imperceptible: no evidence of progress.

1 – Very slight: barely noticeable.

2 – Slight: small observable changes.

3 – Moderate: with significant room for further progress.

4 – Significant: most goals achieved.

5 – Excellent: full recovery or improvement.