actual patient

Home/Post Consultation Survey

Post Consultation Survey

We thank you for choosing The Personal Enhancement Center. Providing us with feedback about your recent consultation helps us improve every patient’s overall experience. We appreciate any comments you have regarding your consultation.

Sincerely,
Christopher P. Godek, MD

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Consultation Date:

Please click on the option that most reflects your satisfaction with staff interaction during your consultation:

How did you hear about our practice?

Word of mouth

Magazine

Physician referral

Internet

Patient

Other

Did your consultation meet/exceed expectations?

Yes

Comments

When your consultation was over did you have a good understanding of your surgical plan?

Yes

I wish I knew more

Comments

Do you have any suggestions to improve the consultation experience?

Yes

Comments

If you decided not to have surgery at this time, please indicate the most important factors in that decision:

The financing options discussed with me were inadequate

The cost was too great

The surgeon and I were not on the same page

Other

Comments

Are there any other services that we can provide additional information?

Botox & Injectable Fillers

At-home Skin Care Products

Laser & Skin Care Treatments

CoolSculpting

Other

Comments

Would you refer your friends and family to us?

Yes

I'm not sure

Comments

Additional Comments / Suggestions / Feedback:

Name (optional)

Email (optional)

Schedule your consultation today

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First Name

Last Name

Phone

Address

City

State

Zip Code

Procedure of Interest

Are you Planning to Finance Your Procedure

Tell me if I am pre-qualifed to finance my procedure with PatientFi

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