1. Total Health Systems New Patient Survey

Thank you for visiting Total Health Systems.  We hope you found everything to your satisfaction. We are constantly striving to improve the care we give to our patients. In order to help us assure your future visits are the best experience possible, would you please take a minute to answer a few questions regarding your visit?  Your response is confidential.

For your time and effort,you will receive a $10 coupon on your next visit good towards services, supplements, nutrition and fitness classes good at any location. Please mention coupon code THSSURVEYMONKEY10 on your next visit. Not redeemable for cash.  Thank you for your time.

1. First/Last Name (Optional) If you would like a $10 coupon for filling out this survey, your responses are required. We appreciate your feedback.

2. How did you choose our practice?

3. At which location was your visit?

4. Your impression of the staff/receptionist on your first visit to Total Health Systems:

5. Your impression of our website?

6. Which provider did you see? (Check all that apply)

7. Which massage therapist did you see?

8. Which Personal Trainer did you see?

9. Were your health related questions answered by your physician(s) and/or therapist to your satisfaction? (1=very poor, 5=excellent)

10. If you received an office tour, were you also made aware of these other services that our facilities have to offer? (check all that apply)

11. Overall, how satisfied were you with your Total Health Experience? (1=very poor, 5=excellent)

12. Would you refer us to others?

13. You have the option of providing contact information for those individuals who may benefit from our care. We will contact them on your behalf to schedule a FREE initial consultation. If your referral becomes a patient, you will receive a complimentary 1/2 hour massage. Thank you!

14. YOUR COMMENTS: 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!

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