East to West Wellness - 10-27 Ruth Ave, Brampton On L6Z 4R2

PATIENT SATISFACTION SURVEY

Your feedback is very important to us
Please fill out this short survey and get a chance to win a complementary massage.

Note that all information given is for ETWW business proposes only. 
We ask for Name and email in order to contact you.



Name (first name only is acceptable)
Email address
What was the reason for your visit.
Chronic Pain
Part of MVA or WSIB rehab
General Wellness
Injury not MVA or workplace
Orthotics/Shoes
Relaxation
What services did you receive. You may indicate all that applies.
Massage
Osteopathy
Acupuncture
Chiropractor
Podiatrist
Other
Can you rate the quality of care that you received?
Excellent
Good
Fair
Poor
Can you rate friendliness, knowledge and professionalism of the staff?
Excellent
Good
Fair
Poor
Were the services provided to you helpful to manage and deal with your concerns?
Yes, definately
Yes, generally
No, generally
No, definately
Would you come back if you require any of the services in the future.
Yes, definately
Yes, I will consider it
No, but maybe
No, definately
Would you refer someone to our clinic ?
Yes, definately
Maybe
No, definately
Overall, how satisfied were you with the services provided to you.
Quite satisfied
Mostly satisfied
Indifferent
Dissatisfied
Quite Dissatisfied
Please leave any additional comments or recommendations here. Your feedback is appreciated. THANK YOU