General Office Survey

Name:

Street Address:

City:

State:

Zip:

Email:

Phone:

Preferred Contact Method?

	Telephone
	Email

Enter Verification Characters:

*required information

Dear valued patient:

Our team here at Craft Chiropractic is consistently striving to improve our services and business. Therefore, we need to hear from those whose opinions and suggestions mean the most.....yours!

We would greatly appreciate it if you would take a few minutes to complete the following survey to share your views about our business. We encourage ALL options and views both positive and constructive. If you feel uncomfortable answering any questions, you may skip the question.

We would like to thank you very much for taking the time to complete our survey. We are always looking for ways to improve our services so we can always serve you well.

OFFICE AND STAFF

	Which office did you visit?
	Did you find our business appearance to be neat and clean?
	Did you receive a warm greeting from our staff when you entered our business?
	Did the staff answer all your concerns?
	Are you able to schedule appointments at the times most convenient for you?
	How was the cleanliness and professionalism of our office?
	What services would you like to see at our office?

CHIROPRACTIC CARE

	Can we have the Doctors name that you seen?
	How was the treatment and services you received?
	How was the Doctors explanation of your condition and treatment program?
	How was the length of time the Doctor spend with you?
	How do you feel with the results of your chiropractic treatment?
	Where you seen within a reasonable time frame from the appointment time given to you?

OVERALL

	Would you be returning to our office?
	What products would you like to see at our offices?
	Please feel free to give any positive or constructive comments to help us improve.