Check us out:
Home
About Us
Our Doctors
History
Patient Testimonials
Sports Team Affiliations
Services
Financial Policies
Foley Health & Fitness Training
Special Offer
What to do if you've just injured yourself
What to expect on your initial visit
Pre-visit Questionnaire
Patient Satisfaction Survey
New Patient Paperwork
Resources
Tuck Chiropractic Blogs
Chiropractic FAQ
Chiropractic Links
Interested in becoming a Chiropractor?
Resources just for Doctors
Locations
Bedford
Blacksburg
Christiansburg
Spinal Sports Injury Clinic - Christiansburg
Fairlawn
Galax
Hillsville
Pulaski
Roanoke-Cave Spring
Roanoke-Peters Creek
Rocky Mount
Vinton
• Find the Closest Clinic •
Contact Us
Careers
Clinics & Info
Patient Satisfaction Survey
Jump to Bottom
Name
Phone #
Email
Which clinic do you visit for treatment?
Select One
Bedford
Blacksburg
Christiansburg
Fairlawn
Galax
Hillsville
Pulaski
Roanoke-Cave Spring
Roanoke-Peters Creek
Rocky Mount
Vinton
Spinal Sports Injury Clinic
How did you find Tuck Chiropractic Clinic?
Select One
Coupon
Direct Mail
Friends & Family Gift Certificate
Health Fair
Insurance
Internet Search
Lawyer
Medical Referral
Newsletter
Newspaper
Past Patient
Phone Book
Promotional Mailing
Radio
Referral
Sign
Tuckclinic.com
TV
The ease of scheduling my initial appointment.
Excellent
Good
Average
Fair
Poor
The staff was courteous and helpful during initial visit.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
The 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 that the explanation was thorough. 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
Will you continue with the treatment plan for your condition as recommended?
Yes
No
If no, please tell us why.
Didn't like the Doctor
Transportation problems
Poor financial arrangements
Couldn't afford treatments
Treatments didn't help
Staff wasn't courteous
Inconvenient hours
I feel fine after the first adjustment
Too busy to get to the clinic
Insurance won't pay
Adjustments were painful
Other
Long waiting times
If you selected "other", please explain why.
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?
By clicking "Save", you have successfully submitted your questionnaire. Thank you for your time and interest in Tuck Chiropractic Clinic. You will be contacted by a member of our team as soon as possible.
Please ignore this field.
* indicates required fields.
Submit