Clinic Survey Please enable JavaScript in your browser to complete this form.Your Name: (Leave blank if you do not want to add your name)When you called to make an appointment, was the staff member courteous and helpful in finding a suitable time?YesSomewhatNoNot ApplicableUpon arrival, were you greeted in a friendly manner and made to feel comfortable?YesSomewhatNoNot ApplicableWere you seated by your appointment time or advised of any delays?YesSomewhatNoNot ApplicableDid the practitioner take the time to listen and understand your concerns?YesSomewhatNoNot ApplicableDid you feel that you understood the prescribed treatment and all your questions were answered to your satisfaction?YesSomewhatNoNot ApplicableUpon receiving your bill for our services was the amount clearly described?YesSomewhatNoNot ApplicableUpon receiving your bill for our services were payment options discussed?YesSomewhatNoNot ApplicableIf you had a concern during your last visit, do you think it was properly handled by the staff?YesSomewhatNoNot ApplicableDuring your last visit, did you feel that the staff was concerned about your overall well being?YesSomewhatNoNot ApplicableWere you happy with the cleanliness and hygiene in the clinic and treatment room?YesSomewhatNoNot ApplicableUsing the rating of 1 to 5, with 5 being the highest score, how do you rate our clinic?12345Suggestions for Improvement: We are always striving to improve our services. Your comments are important to us. How may we serve you better?Submit Survey
