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Click here to see what others are saying. . .

Please take a moment to complete this questionnaire so that we may better serve you and help others decide if we are a good fit for them.  Your time and honest opinion is appreciated.

Name (Optional) Date of Service (Optional)


N/A
Very Poor
Poor

Fair

Good
Very Good The Best
Ease of scheduling my appointment
Paperwork was easy to understand and complete
Staff was courteous and helpful during my visit
Doctor's willingness to listen
Doctor's understanding of my problem(s)
Answers given to my questions
My examination was thorough
My confidence in the chiropractor
Skill and ability of the chiropractor
Explanation of recommended treatment
Overall quality of care / office experience
Did you undergo the recommended treatment plan? Yes No

 
If you did not undergo care, please tell us why. . .

Didn't like the doctor I am too busy Treatments didn't help
Lack confidence in doctor Couldn't afford treatment Adjustments were painful
Staff wasn't courteous Inconvenient hours Other
If "Other" please elaborate

Would you recommend Ace Family Chiropractic to your friends / family? Yes No
If "NO" please tell us why. . .


Other comments?