logo black

Client Satisfaction Questionnaire
Required Required Question(s)

We want to hear from you!

In our ongoing effort to provide you with the best wellness options that benefit your health as well as the quality of your life, we'd like to get your feedback on how we are doing.  Your opinions are very important to us, so please take a moment to fill out this online Client Satisfaction Questionaire and we'll enter you to WIN A FREE 60-minute Wellness Massage as our thanks to you!
 
Required 1.


How did you hear about us?
By referral of a friend, family member or colleague
I found you via a internet search engine
Yelp
Citysearch
I know someone on your Wellness Team
At a Wellness Event
Through one of your partners in the Wellness Community
Other  
Required 2.

How long have you been a patient?
0-3 months
3-6 months
6-12 months
12-24 months
Longer than 24 months
Required 3.


How often do you see us?
Once a week
Two or more times a week
Once a month
Two or more times a month
When I feel the need to
Other  
Required 4.


Is there anything that would help you visit us more?
Later office/treatment hours?
Earlier office/treatment hours?
Sunday hours?
Decreased cash prices?
Different location?
  • Comment:

  • 500 characters left.
Required 5.


Which of the following treatments have you received from us?
Chiropractic Care
Massage Therapy
Acupuncture
Nutritional Counseling
KinesioTaping Method
Aqua Detox
Pregnancy Care
Other  
Required 6.


On a scale of 1 to 5 (with 5 being the best rating) how would you rate the treatments you've received?
 Have not rec'd 1 2 3 4 5 
Chiropractic Care
Massage Therapy
Acupuncture
Nutritional Counseling
KinesioTaping Method
Aqua Detox
Pregnancy Care
  • Comment:

  • 500 characters left.
Required 7.


Do you have insurance that covers your wellness treatments with us?
Yes, through my primary insurance carrier.
Yes, through a supplemental insurance plan.
No, I pay for my wellness care directly.
Required 8.


On a scale of 1 to 5 (with 5 being the best rating), would you please rate your experience with our Front Desk Staff?
1 2 3 4 5       
      
  • Comment:

  • 500 characters left.
Required 9.


Have you used our online booking feature on our website?
Yes
No
  • Comment:

  • 500 characters left.
Required 10.


Which of the following have you taken advantage of?
Our monthly treatment specials
Our monthly retail deals
Our Client Referral Program that earns you a FREE adjustment
Purchasing a gift certificate
Posted a review on Yelp to save 10% on your next treatment
None of the above
Required 11.


Which of the following wellness products have you purchased from us?
Detox Program
Individual nutritional supplements
BioFreeze
Vestibular Disc
Neck Pillow
Knee support pillow
Aromatherapy oils
Naja Tea
None of the above
Other  
Required 12.


Do you read our monthly electronic Wellness Newsletter?
Yes
No
I don't receive this
13.


If you do receive and read our monthly Wellness News, do you find the information helpful?
Not helpful Occasionally helpful Mostly helpful Very helpful Inspiring!       
      
  • Comment:

  • 500 characters left.
Required 14.


How often do you visit our website?
Never
On occasion, just to see what's new
All the time
I use it only to access the online booking feature
15.


Are there any wellness options that you would like to see offered?
 

  • 350 characters left.
Required 16.


Would you be interested in having our team come to your corporate workplace?
Yes
No
17.


If yes, please indicate which of our Corporate Wellness options you'd like more information on:

Chiropractic Care
Massage Therapy
Acupuncture
Nutritional Counseling
Health Seminars
Required 18.


Do you refer your friends, family or colleagues to us?
Yes
No
19.


Why or why not?
 

  • 350 characters left.
20.


If you would like to provide any specific feedback regarding any of our treatments or wellness providers, please feel free to do so.
 

  • 350 characters left.

Thank you for taking time to complete this questionaire.  We value your feedback!

You have now been entered into our sweepstakes to win a FREE 60-minute Wellness Massage!  Good Luck!


We hope to see you soon!

- Dr. Heidi & The InnerMovement Wellness Team