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Your Total Health Experience Questionnaire

5.Total Health Systems New Patient Survey, Tell Us About Your Visit!

Thank you for visiting Total Health Systems!
We’re always looking for ways to improve your experience. Please take a minute to complete this short survey about your recent visit. Your feedback is confidential and greatly appreciated.
Thank you for being a valued part of our community.


1.First/Last Name
2.How did you choose our practice?(Required.)
3.At which location was your visit?(Required.)
4.Your impression of the staff on your first visit to Total Health Systems:(Required.)
5.Which provider did you see? (Check all that apply)
6.Which licensed massage therapist did you see?
7.Were you made aware of these other services that our facilities have to offer? (check all that apply)(Required.)
8.Overall, how satisfied were you with your Total Health Experience? (1=very poor, 5=excellent)(Required.)
9.Would you refer us to others?(Required.)
10.What suggestions would you make to improve our office, staff or procedures? Please be honest, we welcome ideas that will help us to serve you better!(Required.)