We Value You!

We are so honored to have you as a patient at Dr. J Regenerative Medicine.  Our goal is to become better at helping you become better.  In order to serve you the best we can, we would love to know what we are doing well and what we can work on.

Please take a quick minute and give us your feedback of your most recent visit.  We value what you have to say.

Thank You!

    Name

    Email

    Phone xxx-xxx-xxxx


    Survey Questions



     

    Was setting your appointment easy and convenient?

    Not ApplicableStrongly DisagreeSomewhat DisagreeSomewhat AgreeStrongly Agree


    Were you greeted upon arrival?

    Not ApplicableStrongly DisagreeSomewhat DisagreeSomewhat AgreeStrongly Agree


    Did you feel engaged during your visit?

    Not ApplicableStrongly DisagreeSomewhat DisagreeSomewhat AgreeStrongly Agree


    Were your concerns addressed?

    Not ApplicableStrongly DisagreeSomewhat DisagreeSomewhat AgreeStrongly Agree


    Did you feel you left with the information you needed to complete any next steps?

    Not ApplicableStrongly DisagreeSomewhat DisagreeSomewhat AgreeStrongly Agree


    Were you made aware of how the LifeClick™ system is a value to you for your health record?

    Not ApplicableStrongly DisagreeSomewhat DisagreeSomewhat AgreeStrongly Agree


    Were your recommended supplements explained to you?

    Not ApplicableStrongly DisagreeSomewhat DisagreeSomewhat AgreeStrongly Agree


    Were you able to schedule your follow-up visit easily?

    Not ApplicableStrongly DisagreeSomewhat DisagreeSomewhat AgreeStrongly Agree


    Was the check-out process easy and without delays?

    Not ApplicableStrongly DisagreeSomewhat DisagreeSomewhat AgreeStrongly Agree


    What Did We Do Well?

    How Can We Better Serve You?

    I agree to allow Dr. J to use my comments for marketing purposes online and/or print.