BRAINS Satisfaction Survey

Please complete this short survey to let us know about your experience with BRAINS. This feedback helps us to continually improve and grow, and allows us to serve the community the best way we can.

What service(s) were/are you/your child(ren) seen for at BRAINS? Select all that apply

Psychological/Neuropsychological Evaluation (Testing)

AAEC Testing

Individual/Family/Couples Therapy

Group Therapy

Occupational Therapy

Speech Therapy

Court/Legal Services

Applied Behavioral Analysis (ABA)

Other

Please specify other:

Who did/do you/your child(ren) see at BRAINS?

Select all that apply

Please specify other:

Please rate your satisfaction with each of the following categories:

Please check the box below if you would like someone from BRAINS to follow up with you regarding your experience.

I would like someone to follow up

Would you be willing to share your story for our website or social media pages? Checking "yes" does not mean any of your personal information will be shared automatically. Checking "yes" means someone may reach out to you in order to highlight your personal experience with BRAINS.

Yes No

Please leave your contact information below so that we can follow up with you.

Client Name:

Parent/Guardian Name:

If client is under the age of 18

Phone Number:

Email Address:

Please use this box to provide any additional feedback:

Thank you for taking the time to complete our survey. Your experience and feedback are very important to us and we take every response seriously. If you have any questions, please reach out to us at staff@brainspotential.com or 616-365-8920.

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