Thank you for participating in this survey. Your feedback is important to us as we strive to improve our services. This survey should only take a few minutes of your time.

Agreement *

OK

📢 How did you hear about this?

Source *

Online Search

Social Media

Word of Mouth

Referral (Friend/Family)

Advertisement

🎗Were you aware of the services offered by Omega Health Clinics before this survey?

Awareness *

Yes

No

🪜How would you rate your current health status?

Health Status *

Excellent

Good

Fair

Poor

🎖Which of our services are you interested in?

Health Interests *

IV Infusion Therapy

Dietary Consultations

Vitamin Infusions

🤔 What is the primary reason for your interest in our services?

Motivation *

Chronic Illness Management

General Health Improvement

Recommended by a Healthcare Professional

🗓 Would you prefer to book appointments online, over the phone, or both?

Appointment Method *

Online Booking

Over The Phone

Both

🤝 Do you have health insurance that would cover our services?

Insurance *

Yes

No

Contact information

If you would like us to follow up with you, please provide your contact information.

First Name *

Last Name *

Email *

Phone *

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