Feedback Please enable JavaScript in your browser to complete this form.NameFirstLastYour Therapist's Name *How do you feel about your experience with your therapist?How easy was it to make an appointment, change an appointment, or pay your bill?How likely are you to recommend your therapist to a friend or colleague?0123456789100 being not likely and 10 being very likelyHow likely are you to recommend Currence Consulting to a friend or colleague?0123456789100 being not likely and 10 being very likelyIs there anything we can do to make Currence Consulting better?We thank you for allowing us to serve you, and appreciate your taking the time to provide this valuable feedback. Terms of Use *Yes, I want to submit this formBy submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.NameSubmit