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Chiropractic Clinic Patient Satisfaction Survey
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Chiropractic Clinic Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous.

Thank you for your time.

Questions prefixed with an * are required
*1. Age
*2. Gender
*3. Race / Ethnicity
*4. What was the purpose of this visit?
*5. Which chiropractor did you see?
*6. Ease of getting care
Ability to get in to be seen
Hours Center is open
Convenience of Center's location
Prompt return on calls
*7. Waiting
Time in waiting room
Time in exam room
Waiting for tests to be performed
Waiting for test results
*8. Chiropractor
Listens to you
Takes enough time with you
Explains what you want to know
Gives you good advice and treatment
Explains exercises and activities to help my condition
*9. All other staff
Friendly and helpful to you
Answers your questions
*10. Charges / Billing
Cost of services
Explanation of charges
Collection of payment/money
*11. Facility
Neat and clean building
Ease of finding where to go
Comfort and Safety while waiting
*12. Would you refer us to your friends or relatives
13. What do you like best about our center
14. What do you like least about our Center
15. Suggestions for improvement


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