Patient Satisfaction Survey

How did you hear about our office? ---- Select One ----- Friend / Family Advertisement Telephone Book Website Other

Ease of getting through to the doctor's office by phone: ---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

Is the receptionist friendly and courteous on the phone? ---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

What wsa the availability of the Doctor to talk to on the phone? ---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

How was the convenience of the location of the Doctors office? ---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

How was the comfort of the waiting area? ---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

When you came into our office, were you greeted in a friendly, warm manner? ---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

Waiting time to see the Doctor? ---- Select One ----- 0- 10 Minutes 10 - 20 Minutes 20 - 30 Minutes 30 - 45 Minutes 45 + Minutes Comments:

Do the Doctors take time to listen to your questions/concerns and understand your needs? ---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

Do the Doctors explain answers well for you? ---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

Do you find the office furnishings comfortable and inviting? ---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

Have your billing questions/concerns been addressed properly and to your satisfaction?
---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

How would you rate your overall quality of care? ---- Select One ----- Excellent Very Good Good Fair Poor Does not apply

What service were you seen for? ---- Select One ----- Chiropractic Acupuncture Decompression Massage DMV Physicals Drug Testing Feldenkrais / Ttouch Prolotherapy Nutrition Other

Are our hours convenient for you schedule? YES No (Explain):

Would you refer others to this office? YES No

Please comment on anything you found particularly pleasant or unpleasant about your visits.

Please share any ideas with us, so that we may improve our service to you in any way. If you could change one thing about this clinic, what would it be?