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  5. Patient Satisfaction Survey

Patient Satisfaction Survey

Patient Satisfaction Survey
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Questions marked with a * are required Exit Survey
 
 
* How long have you been a patient at Advanced Chiropractic?
 
Less than 6 months
 
6 months to less than 1 year
 
1 year to less than 3 years
 
3 years to less than 5 years
 
5 years or more
 
 
How often do you use our services?
Don't Use Daily Weekly Monthly Quarterly
* Chiropractic with Dr. Bailey
* Massage Therapy with Stephanie
 
 
 
* How would you rate your overall level of satisfaction with of your care?
 
Highly satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Highly dissatisfied
 
 
How do we rate on the following attributes?
Well Below Average Below Average Average Above Average Well Above Average
* Customer Service
* Quality of Care
* Professionalism
* Friendliness
* Value of Care Received
* Understanding of Customers' Needs
 
 
 
* How do we rate in comparison to other chiropractic offices you've been to?
 
Much higher
 
Somewhat higher
 
Same
 
Somewhat lower
 
Much lower
 
I'm not sure
 
 
 
* How likely are you to continue using our services?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
Have you ever recommended us to others?
 
No, never recommended
 
Have recommended once or twice
 
Have recommended several times
 
 
 
Do you have any suggestions for improvement?
   
 
 
 
Would you like to write a testimonial?