How Are We Doing? Survey

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1. When you last telephoned the office were you treated courteously, efficiently and professionally?

When you last telephoned the office were you treated courteously, efficiently and professionally? Yes

If no please explain:

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2. How convenient are our hours for your schedule?

How convenient are our hours for your schedule? Excellent

Good

Fair

Poor

What would be better ?

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3. What are your general impressions of the office?

What are your general impressions of the office? Attractive

Nice

Average

Shabby

Organized & Efficient

Disorganized

A Total Mess

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4. During your last visit, how were you treated by the office front desk staff?

During your last visit, how were you treated by the office front desk staff? As a special individual

Pleasantly

Just another patient

Coldly

Please explain:

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5. Please rate the Doctors/Physical Therapist/Weight Coach on how genuinely interested He/She seem to be in you.

Please rate the Doctors/Physical Therapist/Weight Coach on how genuinely interested He/She seem to be in you. Always seem interested and concerned

Usually seem interested and concerned, a little rushed

Sometimes seem indifferent

Never seem to have enough time for me

How could we improve

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6. The office staff

	Never	Some of the time	Most of the time	Always
work together as a team	*The office staff work together as a team Never	work together as a team Some of the time	work together as a team Most of the time	work together as a team Always
are enthusiastic and enjoy their work	are enthusiastic and enjoy their work Never	are enthusiastic and enjoy their work Some of the time	are enthusiastic and enjoy their work Most of the time	are enthusiastic and enjoy their work Always
are always too rushed to answer questions	are always too rushed to answer questions Never	are always too rushed to answer questions Some of the time	are always too rushed to answer questions Most of the time	are always too rushed to answer questions Always
care about the patients	care about the patients Never	care about the patients Some of the time	care about the patients Most of the time	care about the patients Always
are neat and professional in appearance	are neat and professional in appearance Never	are neat and professional in appearance Some of the time	are neat and professional in appearance Most of the time	are neat and professional in appearance Always

Comments

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7. During office visits, do you think there was adequate explanation of your condition and the treatment you received?

During office visits, do you think there was adequate explanation of your condition and the treatment you received? Yes

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8. Were you satisfied with the Quality of the chiropractic/physical therapy/weigh coaching care you received from this office?

Were you satisfied with the Quality of the chiropractic/physical therapy/weigh coaching care you received from this office? Yes

If No please comment

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9. When you first visited the office, was the financial policy and fee schedule for your insurance explained and easy to understand?

When you first visited the office, was the financial policy and fee schedule for your insurance explained and easy to understand? Yes

If No please comment:

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10. Overall, I rate the

	Poor	Fair	Good	Excellent
Practice	*Overall, I rate the Practice Poor	Practice Fair	Practice Good	Practice Excellent
Doctors	Doctors Poor	Doctors Fair	Doctors Good	Doctors Excellent
Staff	Staff Poor	Staff Fair	Staff Good	Staff Excellent
Weight Coaches	Weight Coaches Poor	Weight Coaches Fair	Weight Coaches Good	Weight Coaches Excellent
Quality of care	Quality of care Poor	Quality of care Fair	Quality of care Good	Quality of care Excellent

Comments

How Are We Doing?Exit this survey

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*1. When you last telephoned the office were you treated courteously, efficiently and professionally?

*2. How convenient are our hours for your schedule?

*3. What are your general impressions of the office?

*4. During your last visit, how were you treated by the office front desk staff?

*5. Please rate the Doctors/Physical Therapist/Weight Coach on how genuinely interested He/She seem to be in you.

*6. The office staff

*7. During office visits, do you think there was adequate explanation of your condition and the treatment you received?

*8. Were you satisfied with the Quality of the chiropractic/physical therapy/weigh coaching care you received from this office?

*9. When you first visited the office, was the financial policy and fee schedule for your insurance explained and easy to understand?

*10. Overall, I rate the

How Are We Doing?
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