Customer Survey

    * Age:
    * Gender:
    * What was the purpose of this visit?
    Which chiropractor did you see?
    If primary care medical services were available at AHW, would you use them?
    * Ease of getting care
    • Excellent
    • Good
    • Fair
    • Poor
    • N/A
    Ability to get in to be seen
    Hours we are open
    Convenience of our location
    Prompt return on calls
    * Waiting
    • Excellent
    • Good
    • Fair
    • Poor
    • N/A
    Time in waiting room
    Time in exam room
    Waiting for tests to be performed
    Waiting for test results
    * Chiropractor
    • Excellent
    • Good
    • Fair
    • Poor
    • N/A
    Listens to you
    Takes enough time with you
    Explains what you want to know
    Gives good advice and treatment
    Explains exercises and activities to help my condition
    * All other staff
    • Excellent
    • Good
    • Fair
    • Poor
    • N/A
    Friendly and helpful to you
    Answers your questions
    * Charges / Billing
    • Excellent
    • Good
    • Fair
    • Poor
    • N/A
    Cost of service
    Explanation of charges
    Collection of payment
    * Facility
    • Excellent
    • Good
    • Fair
    • Poor
    • N/A
    Neat and clean building
    Ease of finding where to go
    Comfort and Safety while waitin
    Privacy
    * Please rate your perception of the professionalism portrayed by our office as a doctor's office responsible for your healthcare:
    • Excellent
    • Good
    • Fair
    • Poor
    • N/A
    * Would you refer us to your friends or relatives?
    What do you like best about Advantage Health and Wellness?
    What do you like least about Advantage Health and Wellness?
    If you have ended your treatment plan prematurely, please tell us why.
    Suggestions for improvement: