Foxworth Chiropractic
Please check the most appropriate response to the following questions:
Does the office staff call you by name?
Do you feel that you’ve received the personal consideration you are entitled to?
Are you made to feel welcome in our office?
Please “Rate our office” in the following areas:
Office Atmosphere
Reading material
Appearance of office
Comfort of office
Please “Rate our office” in the following areas:
Office Staff
Personal appearance
Courtesy
Telephone Manners
Promptness
Professionalism
Explanation of Insurance & Financial Arrangements
Please “rate our office” in the following areas:
Your Doctor’s
Personalized treatment/attention
Explanation of your treatment
Willingness to listen to you
Personal habits and mannerisms
Communication of your progress
Professionalism
Please write in your answers to the following questions:
What things about our office did you like the best?
Your answer
What things did you like the least?
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Would you recommend our office to your friends? Why or why not?
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Have you recommended our office to your friends? If so, what was their response?
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Is there any further information that you desire about our practice or Chiropractic care?
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What other recommendations would you make to allow us to serve you better?
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We would be grateful for you comments and suggestions.
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May we share your survey with others?
Name
Your answer
Date
Your answer
Thank you for participating in our efforts to bring quality Chiropractic Care to our patients!
Dr. Drew Cefalu | Dr. S. Neely Berry | Dr. Victoria Shearer | Dr. Gage Rodriguez
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