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Patient Satisfaction Feedback
Patient Satisfaction Survey
1.
On a scale of 0 to 10,
How likely is it that you would recommend DeYoung Chiropractic to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
2.
Overall, how satisfied or dissatisfied are you with your visit?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
*
3.
Were you greeted in a timely, welcoming manner?
(Required.)
Yes
No
*
4.
How clear was the information that Dr. Aaron provided to you?
(Required.)
Extremely clear
Very clear
Somewhat clear
Not so clear
Not at all clear
5.
Which of the following words would you use to describe our office? Select all that apply.
Professional
Friendly
Quality Care
Clean
Timely
Unwelcoming
Impractical
Ineffective
Lengthy visits
*
6.
How would you rate the quality of your care?
(Required.)
Very high quality
High quality
Neither high nor low quality
Low quality
Very low quality
*
7.
How long have you been an patient at DeYoung Chiropractic?
(Required.)
This was my first visit
Less than six months
Six months to a year
1 - 2 years
3 or more years
8.
Did you or do you plan to revisit DeYoung Chiropractic?
Yes, I already have an appointment
Yes, I plan to reschedule.
Yes, but I may need a reminder.
No, I do not plan to return.
9.
How responsive have we been to your questions or concerns about your symptoms and treatment plan?
Extremely responsive
Very responsive
Somewhat responsive
Not so responsive
Not at all responsive
Not applicable
10.
Would you be willing to leave a review for our website? If so, please write us a review and leave your first name and the initial of your last name.