1.What is your primary reason for seeking chiropractic care?

2.Are you currently seeing a chiropractor?

Yes

No

3.If yes, how often do you visit your chiropractor?

Weekly

Bi-weekly

Monthly

Less frequently

4.How satisfied are you with your current chiropractic care?

Extremely satisfied

Satisfied

Neutral

Dissatisfied

Extremely dissatisfied

5.What specific services offered by a chiropractor excite you the most?

Spinal adjustments

Massage therapy

Physical therapy

Nutritional counseling

Acupuncture

Other

6.What factors influence your decision in choosing a chiropractor?

7.Would you consider trying a new chiropractor? If so, what would motivate you to do so?

8.Please select your age group:

Under 18

18-24

25-34

35-44

45-54

55-64

65 or over

9.What is your gender?

Male

Female

Prefer not to say

10.What is your approximate annual household income?

Under $25,000

$25,000 - $50,000

$50,000 - $75,000

$75,000 - $100,000

Over $100,000