ARC3D Therapy Patient Satisfaction Survey
RequiredRequired Question(s)
Required 1.

For which type of scoliosis were you treated using the ARC3D Therapy Outpatient (2-week) program?

 
Juvenile idiopathic scoliosis
Adolescent idiopathic scoliosis
Adult degenerative scoliosis (de novo)
Neuromuscular scoliosis
I don't know
Required 2.

Did you receive the TornadoSuit, as part of your ARC3D Therapy Outpatient Program?

 
Yes
No
Required 3.

If you answered no to question #2, why not?

 
I was not a candidate
The cost was too much
I was tested for it but it didn't help me
The TornadoSuit was not discussed with me
Required 4.

How would you rate your overall results and/or success using our ARC3D Therapy Program?

 
Unsatisfied Somewhat satisfied Indifferent Satisfied Extremely satisified       
      
5.
How would you rate your level of satisfaction with us?
Highly satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Highly dissatisfied
Required 6.

How do we rate on the following attributes?

 
 Well Below Average Below Average Average Above Average Well Above Average 
Customer service
Professionalism
Quality of ARC3D Therapy
Understanding your needs
Practice staff
Price
  • Comment:

  • 500 characters left.
7.

How likely are you to continue to follow up with us?

 
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
Required 8.

How likely is it that you would recommend our ARC3D Therapy Outpatient Program to a friend or colleague?

 

 
Very likely
Somewhat likely
Neutral
Somewhat unlikely
Very unlikely
9.

Do you have any suggestions for improving our ARC3D Therapy Outpatient Program?

 

 
 

350 characters left.
10.
What is your gender?
Male
Female
Prefer not to answer
11.
Which category describes your age?
Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer
12.
What best describes your employment status?
Employed full-time
Employed part-time
Self-employed
Not employed, but looking for work
Not employed, not looking for work
Retired
Student
Military
Homemaker
Prefer not to answer
Other  
13.
Which category best describes your annual income?
Under $15,000
$15,000 - $29,999
$30,000 - $44,999
$45,000 - $59,999
$60,000 - $74,999
$75,000 - $89,999
$90,000 or more
Prefer not to answer