Universal Chiropractic Patient Satisfaction Survey

Universal Chiropractic needs your feedback! Please take a moment and help us to improve the experiences of future patients and provide better care. When you complete this survey you have a 1 in 10 chance of winning a free 10-minute chair massage from our new massage therapist.

Thank you!

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* 1. Your name, the date of your first visit, and your email (so we can let you know if you've won the chair massage).

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* 2. What is your Chiropractor's name?

Dr. Richard Ziarkowski

Dr. Alana Flitt

Dr. Marshall Dornink

Dr. Tarah M. Wetherby

Dr. Randall Thompson

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* 3. Ease of getting care

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
It was fast and easy to schedule my appointment.	It was fast and easy to schedule my appointment. Strongly Disagree	It was fast and easy to schedule my appointment. Disagree	It was fast and easy to schedule my appointment. Neutral	It was fast and easy to schedule my appointment. Agree	It was fast and easy to schedule my appointment. Strongly Agree
I was able to be scheduled for an appointment the same day.	I was able to be scheduled for an appointment the same day. Strongly Disagree	I was able to be scheduled for an appointment the same day. Disagree	I was able to be scheduled for an appointment the same day. Neutral	I was able to be scheduled for an appointment the same day. Agree	I was able to be scheduled for an appointment the same day. Strongly Agree
I was able to be scheduled with the doctor of my choice.	I was able to be scheduled with the doctor of my choice. Strongly Disagree	I was able to be scheduled with the doctor of my choice. Disagree	I was able to be scheduled with the doctor of my choice. Neutral	I was able to be scheduled with the doctor of my choice. Agree	I was able to be scheduled with the doctor of my choice. Strongly Agree
The staff was very courteous while setting up my appointment.	The staff was very courteous while setting up my appointment. Strongly Disagree	The staff was very courteous while setting up my appointment. Disagree	The staff was very courteous while setting up my appointment. Neutral	The staff was very courteous while setting up my appointment. Agree	The staff was very courteous while setting up my appointment. Strongly Agree
The staff answered all my questions about my visit.	The staff answered all my questions about my visit. Strongly Disagree	The staff answered all my questions about my visit. Disagree	The staff answered all my questions about my visit. Neutral	The staff answered all my questions about my visit. Agree	The staff answered all my questions about my visit. Strongly Agree
All phone calls were returned in a timely manner.	All phone calls were returned in a timely manner. Strongly Disagree	All phone calls were returned in a timely manner. Disagree	All phone calls were returned in a timely manner. Neutral	All phone calls were returned in a timely manner. Agree	All phone calls were returned in a timely manner. Strongly Agree
It was easy to find a park spot.	It was easy to find a park spot. Strongly Disagree	It was easy to find a park spot. Disagree	It was easy to find a park spot. Neutral	It was easy to find a park spot. Agree	It was easy to find a park spot. Strongly Agree
The office is in a convenient location.	The office is in a convenient location. Strongly Disagree	The office is in a convenient location. Disagree	The office is in a convenient location. Neutral	The office is in a convenient location. Agree	The office is in a convenient location. Strongly Agree

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* 4. Waiting Time

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I did not have to wait long to schedule an appointment	I did not have to wait long to schedule an appointment Strongly Disagree	I did not have to wait long to schedule an appointment Disagree	I did not have to wait long to schedule an appointment Neutral	I did not have to wait long to schedule an appointment Agree	I did not have to wait long to schedule an appointment Strongly Agree
I did not have to wait long in the waiting room.	I did not have to wait long in the waiting room. Strongly Disagree	I did not have to wait long in the waiting room. Disagree	I did not have to wait long in the waiting room. Neutral	I did not have to wait long in the waiting room. Agree	I did not have to wait long in the waiting room. Strongly Agree
I did not have to wait long in the exam room.	I did not have to wait long in the exam room. Strongly Disagree	I did not have to wait long in the exam room. Disagree	I did not have to wait long in the exam room. Neutral	I did not have to wait long in the exam room. Agree	I did not have to wait long in the exam room. Strongly Agree
I did not have to wait long between services.	I did not have to wait long between services. Strongly Disagree	I did not have to wait long between services. Disagree	I did not have to wait long between services. Neutral	I did not have to wait long between services. Agree	I did not have to wait long between services. Strongly Agree

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* 5. Your Chiropractor

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
The Chiropractor was courteous and friendly.	The Chiropractor was courteous and friendly. Strongly Disagree	The Chiropractor was courteous and friendly. Disagree	The Chiropractor was courteous and friendly. Neutral	The Chiropractor was courteous and friendly. Agree	The Chiropractor was courteous and friendly. Strongly Agree
The Chiropractor spent enough time with me during my visit.	The Chiropractor spent enough time with me during my visit. Strongly Disagree	The Chiropractor spent enough time with me during my visit. Disagree	The Chiropractor spent enough time with me during my visit. Neutral	The Chiropractor spent enough time with me during my visit. Agree	The Chiropractor spent enough time with me during my visit. Strongly Agree
The Chiropractor explained my injury/problem to me in a way I could understand.	The Chiropractor explained my injury/problem to me in a way I could understand. Strongly Disagree	The Chiropractor explained my injury/problem to me in a way I could understand. Disagree	The Chiropractor explained my injury/problem to me in a way I could understand. Neutral	The Chiropractor explained my injury/problem to me in a way I could understand. Agree	The Chiropractor explained my injury/problem to me in a way I could understand. Strongly Agree
The Chiropractor showed concern for my questions and worries.	The Chiropractor showed concern for my questions and worries. Strongly Disagree	The Chiropractor showed concern for my questions and worries. Disagree	The Chiropractor showed concern for my questions and worries. Neutral	The Chiropractor showed concern for my questions and worries. Agree	The Chiropractor showed concern for my questions and worries. Strongly Agree
The Chiropractor was able to answer my questions and sufficiently explain my plan of care.	The Chiropractor was able to answer my questions and sufficiently explain my plan of care. Strongly Disagree	The Chiropractor was able to answer my questions and sufficiently explain my plan of care. Disagree	The Chiropractor was able to answer my questions and sufficiently explain my plan of care. Neutral	The Chiropractor was able to answer my questions and sufficiently explain my plan of care. Agree	The Chiropractor was able to answer my questions and sufficiently explain my plan of care. Strongly Agree
The Chiropractor provided a comfortable and inviting atmosphere.	The Chiropractor provided a comfortable and inviting atmosphere. Strongly Disagree	The Chiropractor provided a comfortable and inviting atmosphere. Disagree	The Chiropractor provided a comfortable and inviting atmosphere. Neutral	The Chiropractor provided a comfortable and inviting atmosphere. Agree	The Chiropractor provided a comfortable and inviting atmosphere. Strongly Agree
The Chiropractor was thorough and gave me a great sense of confidence in his ability to help me.	The Chiropractor was thorough and gave me a great sense of confidence in his ability to help me. Strongly Disagree	The Chiropractor was thorough and gave me a great sense of confidence in his ability to help me. Disagree	The Chiropractor was thorough and gave me a great sense of confidence in his ability to help me. Neutral	The Chiropractor was thorough and gave me a great sense of confidence in his ability to help me. Agree	The Chiropractor was thorough and gave me a great sense of confidence in his ability to help me. Strongly Agree
I would recommend this Chiropractor to a friend.	I would recommend this Chiropractor to a friend. Strongly Disagree	I would recommend this Chiropractor to a friend. Disagree	I would recommend this Chiropractor to a friend. Neutral	I would recommend this Chiropractor to a friend. Agree	I would recommend this Chiropractor to a friend. Strongly Agree
When I'm treated by other Chiropractors in the office, the care is just as good.	When I'm treated by other Chiropractors in the office, the care is just as good. Strongly Disagree	When I'm treated by other Chiropractors in the office, the care is just as good. Disagree	When I'm treated by other Chiropractors in the office, the care is just as good. Neutral	When I'm treated by other Chiropractors in the office, the care is just as good. Agree	When I'm treated by other Chiropractors in the office, the care is just as good. Strongly Agree

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* 6. Care and Outcomes

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
My treatment plan is specifically designed for me and addresses all of my complaints.	My treatment plan is specifically designed for me and addresses all of my complaints. Strongly Disagree	My treatment plan is specifically designed for me and addresses all of my complaints. Disagree	My treatment plan is specifically designed for me and addresses all of my complaints. Neutral	My treatment plan is specifically designed for me and addresses all of my complaints. Agree	My treatment plan is specifically designed for me and addresses all of my complaints. Strongly Agree
My treatment was comfortable and did not worsen my symptoms.	My treatment was comfortable and did not worsen my symptoms. Strongly Disagree	My treatment was comfortable and did not worsen my symptoms. Disagree	My treatment was comfortable and did not worsen my symptoms. Neutral	My treatment was comfortable and did not worsen my symptoms. Agree	My treatment was comfortable and did not worsen my symptoms. Strongly Agree
My symptoms have improved since my treatment began.	My symptoms have improved since my treatment began. Strongly Disagree	My symptoms have improved since my treatment began. Disagree	My symptoms have improved since my treatment began. Neutral	My symptoms have improved since my treatment began. Agree	My symptoms have improved since my treatment began. Strongly Agree
I will continue with my treatment plan as recommended to the best of my ability.	I will continue with my treatment plan as recommended to the best of my ability. Strongly Disagree	I will continue with my treatment plan as recommended to the best of my ability. Disagree	I will continue with my treatment plan as recommended to the best of my ability. Neutral	I will continue with my treatment plan as recommended to the best of my ability. Agree	I will continue with my treatment plan as recommended to the best of my ability. Strongly Agree
I am interested in receiving nutritional counseling from my Chiropractor.	I am interested in receiving nutritional counseling from my Chiropractor. Strongly Disagree	I am interested in receiving nutritional counseling from my Chiropractor. Disagree	I am interested in receiving nutritional counseling from my Chiropractor. Neutral	I am interested in receiving nutritional counseling from my Chiropractor. Agree	I am interested in receiving nutritional counseling from my Chiropractor. Strongly Agree
I am interested in using Chiropractic to improve my athletic performance.	I am interested in using Chiropractic to improve my athletic performance. Strongly Disagree	I am interested in using Chiropractic to improve my athletic performance. Disagree	I am interested in using Chiropractic to improve my athletic performance. Neutral	I am interested in using Chiropractic to improve my athletic performance. Agree	I am interested in using Chiropractic to improve my athletic performance. Strongly Agree
I am interested in continuing with Chiropractic care after my symptoms resolve to prevent future aches and pains.	I am interested in continuing with Chiropractic care after my symptoms resolve to prevent future aches and pains. Strongly Disagree	I am interested in continuing with Chiropractic care after my symptoms resolve to prevent future aches and pains. Disagree	I am interested in continuing with Chiropractic care after my symptoms resolve to prevent future aches and pains. Neutral	I am interested in continuing with Chiropractic care after my symptoms resolve to prevent future aches and pains. Agree	I am interested in continuing with Chiropractic care after my symptoms resolve to prevent future aches and pains. Strongly Agree

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* 7. Staff

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
The receptionist that worked with me was friendly, knowledgeable and professional.	The receptionist that worked with me was friendly, knowledgeable and professional. Strongly Disagree	The receptionist that worked with me was friendly, knowledgeable and professional. Disagree	The receptionist that worked with me was friendly, knowledgeable and professional. Neutral	The receptionist that worked with me was friendly, knowledgeable and professional. Agree	The receptionist that worked with me was friendly, knowledgeable and professional. Strongly Agree
The chiropractic assistant that worked with me was friendly, knowledgeable and professional.	The chiropractic assistant that worked with me was friendly, knowledgeable and professional. Strongly Disagree	The chiropractic assistant that worked with me was friendly, knowledgeable and professional. Disagree	The chiropractic assistant that worked with me was friendly, knowledgeable and professional. Neutral	The chiropractic assistant that worked with me was friendly, knowledgeable and professional. Agree	The chiropractic assistant that worked with me was friendly, knowledgeable and professional. Strongly Agree
The staff was helpful in answering my questions and concerns.	The staff was helpful in answering my questions and concerns. Strongly Disagree	The staff was helpful in answering my questions and concerns. Disagree	The staff was helpful in answering my questions and concerns. Neutral	The staff was helpful in answering my questions and concerns. Agree	The staff was helpful in answering my questions and concerns. Strongly Agree
Paying for services was quick and easy.	Paying for services was quick and easy. Strongly Disagree	Paying for services was quick and easy. Disagree	Paying for services was quick and easy. Neutral	Paying for services was quick and easy. Agree	Paying for services was quick and easy. Strongly Agree
The cost of Chiropractic care is a better value compared to other treatment methods.	The cost of Chiropractic care is a better value compared to other treatment methods. Strongly Disagree	The cost of Chiropractic care is a better value compared to other treatment methods. Disagree	The cost of Chiropractic care is a better value compared to other treatment methods. Neutral	The cost of Chiropractic care is a better value compared to other treatment methods. Agree	The cost of Chiropractic care is a better value compared to other treatment methods. Strongly Agree

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* 8. How could we have made your Chiropractic experience better?

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* 9. Are there any individuals you would like us to recognize for their outstanding service? If yes, please explain why.

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* 10. Please leave a review we can use in our marketing campaigns to let patients know what you love most about Universal Chiropractic!