Injectables Consultation and Consent Form

Client Satisfaction Survey

Thank you for choosing to participate in our Client Satisfaction Survey. Your feedback is essential to help us improve our services and ensure we meet your expectations. Take your time to read through each question and answer accordingly.

First Name *

Last Name *

Phone *

Email *

Date of Visit *

Which services did you receive during your visit? (Please select all that apply) *

Do you have any suggestions on how we can improve our services? *

Would you like to provide any other feedback or comments about your experience? *

I agree to allow PlatinumByApril to use my feedback for the purpose of improving their services and offerings. I understand my responses will be kept confidential and used solely for quality improvement purposes.