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1. Please rate our office:

	Poor		Average		Excellent
Cleanliness-	Please rate our office: Cleanliness- Poor	Cleanliness-	Cleanliness- Average	Cleanliness-	Cleanliness- Excellent
Ambiance-	Ambiance- Poor	Ambiance-	Ambiance- Average	Ambiance-	Ambiance- Excellent
Wait time-	Wait time- Poor	Wait time-	Wait time- Average	Wait time-	Wait time- Excellent
Hours-	Hours- Poor	Hours-	Hours- Average	Hours-	Hours- Excellent
Location-	Location- Poor	Location-	Location- Average	Location-	Location- Excellent
Prices-	Prices- Poor	Prices-	Prices- Average	Prices-	Prices- Excellent

General Comments & Suggestions:

2. Please rate Krissy's

	Poor		Average		Excellent
Professionalism-	Please rate Krissy's Professionalism- Poor	Professionalism-	Professionalism- Average	Professionalism-	Professionalism- Excellent
Efficiency-	Efficiency- Poor	Efficiency-	Efficiency- Average	Efficiency-	Efficiency- Excellent
Attitude-	Attitude- Poor	Attitude-	Attitude- Average	Attitude-	Attitude- Excellent
Knowledge-	Knowledge- Poor	Knowledge-	Knowledge- Average	Knowledge-	Knowledge- Excellent

General Comments & Suggestions:

3. Please rate Dr. Marsh's

	Poor		Average		Excellent
Knowledge-	Please rate Dr. Marsh's Knowledge- Poor	Knowledge-	Knowledge- Average	Knowledge-	Knowledge- Excellent
Ability to educate you about your diagnosis-	Ability to educate you about your diagnosis- Poor	Ability to educate you about your diagnosis-	Ability to educate you about your diagnosis- Average	Ability to educate you about your diagnosis-	Ability to educate you about your diagnosis- Excellent
Professionalism-	Professionalism- Poor	Professionalism-	Professionalism- Average	Professionalism-	Professionalism- Excellent
Listenging skills-	Listenging skills- Poor	Listenging skills-	Listenging skills- Average	Listenging skills-	Listenging skills- Excellent
Bedside manner-	Bedside manner- Poor	Bedside manner-	Bedside manner- Average	Bedside manner-	Bedside manner- Excellent
Chiropractic manipulation skills-	Chiropractic manipulation skills- Poor	Chiropractic manipulation skills-	Chiropractic manipulation skills- Average	Chiropractic manipulation skills-	Chiropractic manipulation skills- Excellent
Physical Therapy skills	Physical Therapy skills Poor	Physical Therapy skills	Physical Therapy skills Average	Physical Therapy skills	Physical Therapy skills Excellent

General Comments & Suggestions:

4. If applicable...Please rate E-Billing Solutions'

	N/A	Poor		Average		Excellent
Phone Skills-	If applicable...Please rate E-Billing Solutions' Phone Skills- N/A	Phone Skills- Poor	Phone Skills-	Phone Skills- Average	Phone Skills-	Phone Skills- Excellent
Availibility-	Availibility- N/A	Availibility- Poor	Availibility-	Availibility- Average	Availibility-	Availibility- Excellent
Professionalism-	Professionalism- N/A	Professionalism- Poor	Professionalism-	Professionalism- Average	Professionalism-	Professionalism- Excellent
Attitude-	Attitude- N/A	Attitude- Poor	Attitude-	Attitude- Average	Attitude-	Attitude- Excellent
Knowledge of insurance billing-	Knowledge of insurance billing- N/A	Knowledge of insurance billing- Poor	Knowledge of insurance billing-	Knowledge of insurance billing- Average	Knowledge of insurance billing-	Knowledge of insurance billing- Excellent
Knowledge of appeals process	Knowledge of appeals process N/A	Knowledge of appeals process Poor	Knowledge of appeals process	Knowledge of appeals process Average	Knowledge of appeals process	Knowledge of appeals process Excellent

General Comments & Suggestions:

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