Client Questionnaire

Hello:
You are invited to participate in our questionnaire. In this questionnaire people will be asked to answer questions about themselves. It will take approximately 15 -20 minutes to complete the questionnaire.

Your participation in this questionnaire is completely voluntary but it will allow me to review your answers prior to your visit with me. There are no foreseeable risks associated with this questionnaire, it will provide me some insight on your concerns However, if you feel uncomfortable answering any questions, you can hold off until we meet in present. It is very important for me to learn and understand the reason for your visit.

Your questionnaire responses and every appointment with me will be strictly confidential. Your information will remain confidential. If you have questions at any time about the questionnaire, you may contact me via phone and/or email at the email.

Thank you very much for your time. Please start with the survey now by clicking on the Continue button below.