Thank you for taking our customer service questionnaire.

It will take only 1-2 minutes to complete. We appreciate your business and value your opinion. We’ll use your opinions to take stock of our service and support and to make improvements.

All your answers are confidential and help us to serve you better.

1. How would you rate the cleanliness and environment of the clinic?
Required Question

2. How well were your insurance benefits or costs explained to you?
Required Question

3. How would you rate the overall process of scheduling appointments?
Required Question

4. How satisfied were you with the explanation of your diagnosis, if given?
Required Question

5. How well were you shown things that you can do on your own to prevent future illness (i.e. changes to your lifestyle, work space, exercises)?
Required Question

6. When receiving your treatment options, how well were you informed of any risks, if applicable?
Required Question

7. How satisfied would you say you were with your treatment experience?
Required Question

8. How highly would you recommend Dr. Hehn as a chiropractor to others?
Required Question

9. How highly would you recommend Dr. Brooke as a medical doctor to others? Required Question

10. How highly would you recommend the Massage Therapist to others? Required Question

11. How would you rate the ability of our staff to anticipate your needs and exceed expectations?
Required Question

12. How did you hear about our clinic?
Required Question

13. What else could we do better? Do you have any comments?

Very Satisfied	Satisfied	Neutral	Not Satisfied	Very Dissatisfied	N/A

Very Satisfied	Satisfied	Neutral	Not Satisfied	Very Dissatisfied	N/A

Very Satisfied	Satisfied	Neutral	Not Satisfied	Very Dissatisfied	N/A

Very Satisfied	Satisfied	Neutral	Not Satisfied	Very Dissatisfied	N/A

Very Satisfied	Satisfied	Neutral	Not Satisfied	Very Dissatisfied	N/A

	Friend
	Doctor/Lawyer Referral
	Internet/Web Search (ie... Google, Yahoo)
	Saw the clinic
	Other