949-631-3321
881 Dover Drive #285
Newport Beach, CA 92663
949-631-3321
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Question marked with * are mandatory.
PATIENT SATISFACTION SURVEY
We appreciate your written comments to add to our website testimonials page..... Thank You !
Q1.
During Your Visits *
Poor
Fair
Good
Very Good
Excellent
1. Courtesy of staff at the front desk
2. Length of wait before going to the treatment area
3. Comfort and pleasantness of treatment area
Q2.
Your Therapist *
Strongly Disagree
Somewhat Disagree
Somewhat Agree
Agree
Strongly Agree
1. Can view things from my perspective (see things as I see them)
2. Understands my emotions, feelings and concerns
3. Was knowledgeable and clearly explained my condition/injury to me
4. Was skillful in treating me
Comment (describe good or bad experiences)
Q3.
Appointment Setting *
Poor
Fair
Good
Very Good
Excellent
1. Ease of scheduling your appointments
2. Courtesy of person who scheduled your appointment
Other
Q4.
Your likelihood of recommending our clinic to your friends and relatives *
1
2
3
4
5
6
7
8
9
10
Q5.
What is the most important improvement we can make?
Q6.
Add any other comments below
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