First Name

Last Name

Email Address

Number Of Consultations

Name of Clinician

Have you read our complaints handling process? Have you read our complaints handling process? Yes No

Did you discuss your concerns with your clinician? Did you discuss your concerns with your clinician? Yes No

If no, was there a specific reason?

Are you willing to discuss your concerns with your clinician if given Entelechy Therapy managerial support? Are you willing to discuss your concerns with your clinician if given Entelechy Therapy managerial support? Yes No

If not, how would you prefer your concerns to be handled?