Massage Patient Survey

    Your Name

    Your Email

    Please answer yes or no.

    Were you greeted by name when you visited the office?

    Were you seen by the doctor during your expected time frame?

    Was the office staff warm and friendly?

    Were your treatments without discomfort?

    Please rate each of the following with a score of 1 to 5, with 5 being the highest. Any additional comments can be added at the end.

    The Office

    First Impression:

    Seating comfort:

    Reading Materials:

    Parking Facilities:

    Office Hours:


    Office Staff


    Promptness in Greeting:


    Answering of Questions:

    Billing Matters:

    Making you feel comfortable:

    Overall Rating of Staff:

    The Doctor

    Attention to your concerns:

    Answering of your questions:

    Clarity in explaining condition and treatment:

    Explanation of fees:

    General Professionalism:

    Overall health care education:

    What do you like best about our office?

    What do you like least about our office?