Testimonials

Client Experience Questionnaire

Our mission is to maintain a dedicated, caring and knowledgeable team committed to providing exceptional client services and Chiropractic Care. We strive toward this excellence through continuing education, technical advances and compassionate care for all of our patients.

You can help us reach and maintain this level of service by sharing your chiropractic needs and expectations. By completing this client survey, you will be a part of our team meetings and be assured that your comments will be discussed and acted upon. Thank you for your time and effort.

Your Impression of our Doctor:

Introduced himself/herself
YesNo
Listened to what I said
YesNo
Gave clear advice
YesNo
Answered all my questions
YesNo
Made me feel valued
YesNo
Seemed proficient and knowledgeable
YesNo
Gave me the information I needed
YesNo
Additional Questions:

Was your waiting time reasonable?
YesNo
Do you feel the fees were reasonable?
YesNo
Did you understand all our fees?
YesNo

If you marked "No" please explain.

Will you recommend us to others?
YesNo

Why or why not?

What suggestions do you have for improving the office, staff or procedures?
If you would like us to contact you, please fill out the necessary information.

Download & Print Questionnaire

We value our patients’ experience at Health and Wellness Chiropractic Center. If you are currently a chiropractic patient, please feel free to complete the following Client Experience Questionnaire. The Questionnaire is in Adobe Acrobat format, and requires the free Acrobat Reader to view.