Patient Satisfaction Survey

Name (optional)

Was this your first visit to Salem Chiropractic Center?*
Yes
No

Did you have a morning or afternoon/evening appointment? *
AM
PM

Were you greeted in a courteous and pleasant manner? *
Yes
No

Were you seen within 15 minutes of your scheduled appointment time? *
Yes
No

Was the doctor's assistant pleasant and efficient? *
Yes
No

Your doctor:*
Dr. Glenn Kneeland
Dr. Donna Kneeland
Dr. Mitch Kneeland

Were you satisfied with the time and treatment provided by the doctor that treated you? *
Yes
No

Was your experience at check-out efficient? *
Yes
No

How would you rate your overall experience at Salem Chiropractic Center?*
1= Unsatisfactory | 10= Excellent
1
2
3
4
5
6
7
8
9
10

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