Good Chi - 2 Minute Survey

Thank you very much for taking the time to fill out this anonymous 6 question survey. We are shooting for perfection at Good Chi Acupuncture and we sincerely appreciate any feedback you have for us.

* = Required information

How many treatments have you had at Good Chi Acupuncture? *

None
One
Several
Other:

Reception Desk

Comments?

Acupuncture Session

How was your acupuncturist? *
Please check all that apply

The acupuncturist had a nice demeanor
The acupuncturist was very knowledgeable and informative
The acupuncturist seemed very skilled
I did not like the acupuncturist’s approach with me
I did not like the acupuncturist’s treatment style
The acupuncturist did not seem like he/she knew what she was doing

Comments about your acupuncturist?

How was your acupuncture treatment? *
Please check all that apply

Comments on your treatment?

Overall Experience

Comments on your overall experience? Any specific comments you have would be greatly appreciated.

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	1	2	3	4	5	6	7	8	9	10
Needs improvement											Fantastic

	1	2	3	4	5	6	7	8	9	10
Poor											Excellent

Good Chi - 2 Minute Survey

Reception Desk

Acupuncture Session

Overall Experience

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