Client Feedback & Acupuncturist Review Survey

1.Which ACUPUNCTURIST are you reviewing with this Survey? Choose the practitioner that treated you and answer the questions for that person only.

Rob Singer L.Ac

Jenny Moore L.Ac

Tonya Tigart L.Ac

Ari Shapiro L.Ac

2.BEDSIDE MANNER: Positive interaction with your Acupuncturist is essential to building trust and rapport. Please check ALL that reflect your experience with your practitioner's Bedside Manner.

My Acupuncturist listened attentively and seemed compassionate to my situation.

My Acupuncturist was calm, confident and capable.

My Acupuncturist respected my boundaries and it was easy to communicate my needs.

My Acupuncturist communicated what to expect during treatment.

Overall, my experience with their Bedside Manner was POSITIVE.

Overall, my experience with their Bedside Manner COULD USE IMPROVEMENT.

Please add any other feedback about Bedside Manner.

3.TREATMENT: Acupuncture is what we do here, so it is important that it is done right. Please check all that reflect your experience with your practitioner's Acupuncture Treatment.

I felt that I had a good quality Acupuncture Treatment and felt cared for.

I was comfortable with the needle sensations and my Acupuncturist checked that I felt ok.

My Acupuncture Treatment was effective - I got relief/ improvement or other benefit.

My Acupuncturist handled needles safely and they were all accounted for before I left.

I felt safe and was able to relax during my Acupuncture Treatment.

Overall, my experience with their Acupuncture Treatment was POSITIVE.

Overall, my experience with their Acupuncture Treatment COULD USE IMPROVEMENT.

Please add any other feedback about your Acupuncture Treatment.

4.TIME MANAGEMENT: Even though we can get busy, it's important that we don't keep you waiting too long. Please check all that reflect your experience withyour practitioner's Time Management.

Chairs were clean and available - I did not have to wait to be seated.

I was seen in a timely manner - I didn't have to wait long past my appointment time to be seen.

If I needed anything, my Acupuncturist responded quickly and it was easy to get their attention.

When I was done and ready, I was attended to for needle removal promptly.

My treatment time (resting with the needles) was sufficient - not too long or too short.

Overall, my experience with their Time Management was POSITIVE.

Overall, my experience with their Time Management COULD USE IMPROVEMENT.

Please add any other feedback about Time Management.

5.COMFORT: Acupuncture is supposed to be relaxing, so it's important that you feel comfy. Please check ALL that reflect your Comfort during your practitioner's treatment.

I was warm enough during treatment and blanket draping was comfortable.

I was comfortable in my chair and was reclined to a good position.

The treatment space was calm and quiet - I wasn't disturbed by noise, conversations, etc.

I was comfortable with the needles during treatment and it was easy to communicate if something didn't feel right.

Overall, my Comfort during their treatment was POSITIVE.

Overall, my Comfort during their treatment COULD USE IMPROVEMNT.

Please add any other feedback about your Comfort during your treatment.

6.FUTURE RECOMMENDATIONS: Community Acupuncture relies on you having a good experience and wanting to share that with others. Please check ALL that reflect your Future Recommendations for the Acupuncturist you are reviewing.

I would return for a treatment with this Acupuncturist again.

I would return for a treatment, but prefer to not see this Acupuncturist in the future.

Their regular schedule is not convenient for my return visits.

I would recommend this Acupuncturist to friends and family.

Please offer any feedback about your experience with your Acupuncturist and how if affects your Future Recommendations.

Client Feedback & Acupuncturist Review Survey

Acupuncturist Performance Review