Waukee Wellness Survey
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1
. How would you rate your experience with the following:
Poor
Excellent
Appearance of our Office
*
How would you rate your experience with the following: Appearance of our Office Poor
Appearance of our Office
Appearance of our Office
Appearance of our Office Excellent
Our Staff
Our Staff Poor
Our Staff
Our Staff
Our Staff Excellent
Dr. Wes
Dr. Wes Poor
Dr. Wes
Dr. Wes
Dr. Wes Excellent
Service
Service Poor
Service
Service
Service Excellent
2
. Please mark all services you have used at our office:
Please mark all services you have used at our office:
Chiropractic Adjustments
Massage
Personal Training
Exercise Class
Health Care Class
8 Weeks to Wellness
Supplements
*
3
. Have you referred a patient to our office? Why or why not?
Have you referred a patient to our office? Why or why not?
*
4
. Why do you come to Waukee Wellness?
Why do you come to Waukee Wellness?
*
5
. Please give us any additional comments. These can be the most helpful. Thank you!
Please give us any additional comments. These can be the most helpful. Thank you!
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