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Exit Survey
 
 
When did you last visit our office?
 
In the past week
 
In the past month
 
In the past 3 months
 
In the past year
 
It's been quite a while!
 
 
 
Overall, how satisfied were you with your last chiropractic visit?
 
Very satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Very dissatisfied
 
 
Please indicate the degree to which you agree/disagree with the following statements on our customer service.
Strongly Disagree Somewhat Disagree Neutral Somewhat Agree Strongly Agree
Our staff is professional
Our staff is attentive to your needs
Our staff is courteous and polite
Our staff strives to meet your scheduling needs
 
 
Comment: (We value your honest feedback)
   
 
 
Please indicate the degree to which you agree/disagree with the following statements about our office and services.
Strongly Disagree Somewhat Disagree Neutral Somewhat Agree Strongly Agree
The office location/parking is convenient
The office has a neat and clean appearance
The office wait times are reasonable
 
 
 
How likely is it that you would refer friends and family to our office?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
Do you have any suggestions for improvement?