PLC Patient Happiness Survey (Active)
ANONYMOUS FEEDBACK FROM ACTIVE PATIENTS
Describe your current status with Pure Life Chiropractic:
Active patient completing a corrective care plan
Active patient who has already completed a corrective care plan
Past patient or currently taking a break
Not yet a patient
What level of care have you completed?
Did NOT make it to the initial consultation & exam
Attended initial consultation / exam ONLY
Attended initial consultation / exam and report of findings ONLY
Attended all initial visits and began a corrective care plan
Completed a corrective care plan
Massage only visit
What benefits have you experienced since beginning care? (Select all that are applicable)
Decreased pain
Less medications
Increased mobility
Increased energy
Better posture
Improved alignment of your spine
Improved activities of daily living
Other
Please rate your satisfaction in the following categories:
Rows
Very Happy
Happy
Somewhat Happy
Not Happy
Ease of scheduling & office policies
Cleanliness and appearance of our facility
Friendliness of service
Overall care from providers
Achievement of your health goals
How likely is it that you would recommend Pure Life Chiropractic to a friend or colleague?
Not at all likely
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not at all likely , 10 is Extremely likely
What can we do to improve?
Comments / Suggestions
Submit
Should be Empty: