Phone #:
(610) 841-2204
Email:
Info@CompleteChiroCenter.com
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Comments/Survey
Please feel free to fill out the Patient Survey and/or Comments
Survey and Comments
Name: (optional)
E-mail: (optional)
Percentage of Improvement:
List all activities you can do better since starting treatment at Complete Chiropractic:
List all activities you still cannot do that you would like to be able to do:
The treatment and services you received:
Very Satisfied
Satisfied
Neither satified nor unsatified
Unsatisifed
Very Unsatisfied
The doctor's explanation of your condition and treatment plan:
Very Satisfied
Satisfied
Neither satified nor unsatified
Unsatisifed
Very Unsatisfied
The length of time the doctor spent with you:
Very Satisfied
Satisfied
Neither satified nor unsatified
Unsatisifed
Very Unsatisfied
Your results with treatment:
Very Satisfied
Satisfied
Neither satified nor unsatified
Unsatisifed
Very Unsatisfied
The promptness of service:
Very Satisfied
Satisfied
Neither satified nor unsatified
Unsatisifed
Very Unsatisfied
The friendliness and concern of the doctors:
Very Satisfied
Satisfied
Neither satified nor unsatified
Unsatisifed
Very Unsatisfied
The cleanliness and professionalism of our office:
Very Satisfied
Satisfied
Neither satified nor unsatified
Unsatisifed
Very Unsatisfied
The availability of convenient appointment times:
Very Satisfied
Satisfied
Neither satified nor unsatified
Unsatisifed
Very Unsatisfied
The explanation of your insurance benefits
Very Satisfied
Satisfied
Neither satified nor unsatified
Unsatisifed
Very Unsatisfied
Is there a testimonial you would like to give for our use in marketing and public relation?:
Comments/Suggestions:
Phone
#: (610) 841-2204
Phone
#: (610) 841-2204