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*1. Age:
---Under 1818-3031-4546-6060+

*2. Gender:
---MaleFemale

*3. What town are you from:
---CumberlandBarronBarronettCameronClaytonLuckRice LakeShell LakeSpoonerTurtle LakeOther

*4. What was the purpose of the visit:
---Neck PainHeadachesLow Back PainShoulder PainWhiplash injurySciaticaWellnessOther

*5. What Chiropractor did you see:
---Dr. Tom ToftnessDr. Jodi Griffith

*6. Ease of making an appointment:
---ExcellentGoodFairPoor

*7. Prompt return of calls:
---ExcellentGoodFairPoor

*8.Time in waiting room:
---ExcellentGoodFairPoor

*9. Time in treatment room:
---ExcellentGoodFairPoor

*10. Chiropractor took enough time with you:
---ExcellentGoodFairPoor

*11. Chiropractor explains your condition to you:
---ExcellentGoodFairPoor

*12. Chiropractor explains exercises and activities to help my condition:
---ExcellentGoodFairPoor

*13. All the staff was friendly to you:
---ExcellentGoodFairPoor

*14. Cost of services:
---ExcellentGoodFairPoor

*15. Explanation of the charges:
---ExcellentGoodFairPoor

*16. Was the clinic neat and clean:
---ExcellentGoodFairPoor

*17. Was the clinic easy to find:
---ExcellentGoodFairPoor

*18. Do you feel there was adequate privacy:
---ExcellentGoodFairPoor

*19. Would you refer friends or relatives:
---YesMaybeNo

20. What did you like best about our clinic

21. What did you like least about our clinic

Additional Information