Foxworth Chiropractic
Please check the most appropriate response to the following questions:
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Does the office staff call you by name?
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Do you feel that you’ve received the personal consideration you are entitled to?
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Are you made to feel welcome in our office?
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Please “Rate our office” in the following areas:
Office Atmosphere
Reading material
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Appearance of office
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Comfort of office
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Please “Rate our office” in the following areas:
Office Staff
Personal appearance
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Courtesy
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Telephone Manners
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Promptness
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Professionalism
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Explanation of Insurance & Financial Arrangements
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Please “rate our office” in the following areas:
Your Doctor’s
Personalized treatment/attention
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Explanation of your treatment
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Willingness to listen to you
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Personal habits and mannerisms
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Communication of your progress
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Professionalism
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Please write in your answers to the following questions:
What things about our office did you like the best?
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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?
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Name
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Date
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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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