To thank you for responding to our survey, we will issue a $10 gift certificate for
services at our Silhouette Laser Clinic (www.silhouette.ca) to every former
patient who takes the time to answer our questionnaire below.

Please note: in accordance with the Privacy Act of Canada, completion of
our survey form shall be your authorization for us to send you a gift
certificate at the address you enter on the form.

We value your opinion and we want to hear from you.

Please be honest in your assessment of our care and service; your satisfaction
and feedback are important to us and help us to continually improve our client
service at every level.

When you have finished filling out the form, please click Submit.  Your gift
certificate will be mailed to you at the address you have provided.  Thank you!