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The ease of scheduling my first appointment
Excellent Good Average Fair Poor
 
 
 
How satisfied are you with the following:
Strongly Agree Agree Neutral Disagree Strongly Disagree
Staff was courteous and helpful during initial visit.
Paperwork was easy to understand and fill out
During my initial visit the Doctor was attentive and listened to my needs
During my exam, the doctor was thorough and gave me a great sense of confidence in her ability to help me
I fully understood the Doctors explanation of her findings, and her recommendations for my treatment.
I felt the Doctor prepared me for my first adjustment, and adjusted me with little to no discomfort
My insurance coverage was explained to me in a satisfactory manner.
 
 
Overall my inital experinece was...
Excellent Good Average Fair Poor
 
 
 
How likely are you to recommend our office to family and friends 
Very Likely Not Likely Neutral
 
 
 
 
If not likely, please tell us why
 
Did not like the doctor
 
Could not afford treatments
 
Inconvenient hours
 
Insurance will not pay
 
Long waiting times
 
Treatment did not help
 
Transportation problems
 
I feel fine after the first adjustment
 
Adjustments were painful
 
Staff was not courteous
 
Too busy to get to the clinic
 
Other

 
 
 
If you selected other, please explain why.
   
 
 
 

If you have chosen not to continue care following your initial acute phase (typically 15-30 visits) please indicate reason(s) below 

 
Maxed out insurance coverage
 
Cannot afford/did not want to pay out of pocket
 
Felt great and didn't see need to return
 
Other
 

 
 
 
What do you like most about In Good Hands Chiropractic, and if you could do one thing to improve our office, what would it be?