New Patient Survey

New Patient Survey

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1. Which office do you visit for treatment?



2. How did you find us?




3. Please fill out the following multiple choice questions:

Ease of scheduling initial appointment
Excellent Good Average Fair Poor


Staff was courteous and helpful during initial visit
Strongly Agree
 Agree Neutral Disagree Strongly Disagree


Paperwork was easy to understand and complete
Strongly Agree
 Agree Neutral Disagree Strongly Disagree


During my initial consultation, the Doctor listened and was attentive to my needs
Strongly Agree
 Agree Neutral Disagree Strongly Disagree


During my exam, the Doctor was thorough and gave me a great sense of confidence in his/her ability to help me.
Strongly Agree
 Agree Neutral Disagree Strongly Disagree


During the Doctor’s explanation of my condition, I felt the explanation was thorough and I understood what was necessary to treat my issues.
Strongly Agree
 Agree Neutral Disagree Strongly Disagree


During the first adjustment, the Doctor explained what to expect and adjusted me with no discomfort
Strongly Agree
 Agree Neutral
 Disagree Strongly Disagree


My insurance was explained to me in detail
Strongly Agree
 Agree Neutral Disagree Strongly Disagree


I was offered financial options to deal with my initial care plans
Strongly Agree
 Agree Neutral
 Disagree Strongly Disagree


Overall, my initial experience was
Excellent Good Average Fair
 Poor


4. Will you continue with the treatment plan for your condition as recommended? If not, please tell us why. (check all that apply)

Didn't like the doctor I feel fine after the first adjustment
Couldn't afford treatments Adjustments were painful
Inconvenient hours Poor financial arrangements
Insurance won't pay Staff wasn't courteous
Long waiting times Too busy to get to office
Transportation problems Other
Treatments didn't help


What do you like most about Tuck Chiropractic Clinic and if you could do one thing to improve Tuck Chiropractic Clinic, what would it be?
Locations:
Blacksburg Christiansburg Fairlawn/Radford Galax Hillsville Pulaski Roanoke - Peters Creek Roanoke - Cave Spring Rocky Mount

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