New Chiropractic Member Survey Thank you for your trust and confidence in DREAM Wellness!We would greatly appreciate you taking 5 minutes of your time to help us help our wellness community by providing feedback about the service(s) you recently received. Your input is extremely valuable as we are always looking to improve the quality of our services. We appreciate the confidence that you have shown in choosing us as your chiropractic care! We will strive to make the person who referred you proud of that referral. Please help us help others by filling out this questionnaire as honestly as possible.Name* First Last Email* Which DREAM Wellness location are you currently receiving chiropractic care?* Pacific Beach Del Mar Santee I go to multiple locations If you were to rate your experience at DREAM Wellness on the "Star" system, how many stars would you give us??* 5 Stars: Excellent 4 Stars: Good 3 Stars: Ok 2 Stars: Fair 1 Star: Poor Were you able to make your initial appointment right away or when it was convenient?* Yes No Please explain why not... Has your experience with our staff been friendly and courteous?* Yes No Please explain why not... Are your appointment times convenient for you?* Yes No What times would be more convenient for you? Were the fees and financial arrangements we agreed upon explained to your satisfaction?* Yes No Explain Do you understand what a vertebral subluxation is; what the affects on your body and health might be; and how to try and avoid them?* Yes No Have you attended our new member orientation or wellness workshop?* Yes No Not yet, but I'm signed up for the next one You haven't had one yet, but I'd like to attend one! Would you like to sign up for our next wellness workshop?* Yes please No thank you It depends on the date and time Great! Did you find that the workshop was a great value of your time?* Yes No Because you valued the workshop, if you would like us to reach out to someone you care about to invite him/her to the next one, please provide us with that person's name, phone number and/or email address.Do you feel you have the confidence in our office to refer your friends and family to us for Chiropractic care?* Yes No If there is someone you would like to refer to DREAM Wellness, please provide us with his/her contact information:The providers at D.R.E.A.M. Wellness are available for outside lectures (frequently at no charge) at your company, club, religious group, etc. If you would like to have one of our providers present to a group you affiliate with, please provide the necessary information here:Is there anything we can do to make your experience here more pleasant?* Yes No Please explain: We're so happy your experience has been so wonderful! Please click here to post a Yelp review to help spread the word of the great work we do. (When you click the link, a new web browser will open so you can write your review after submitting this survey)We're so happy your experience has been so wonderful! Please click here to post a Yelp review to help spread the word of the great work we do. (When you click the link, a new web browser will open so you can write your review after submitting this survey)We're so happy your experience has been so wonderful! Please click here to post a Yelp review to help spread the word of the great work we do. (When you click the link, a new web browser will open so you can write your review after submitting this survey)Would you like to complete the testimonial (success story) survey so you can share your experience with current and future members of this office?* Yes, I'm happy to! No I probably will in the future, but the "jury" is still out Yes I would love to, but I just can't do it at this moment Testimonial: Our Members Speak!The Team at D.R.E.A.M. Wellness would like to take this time to personally thank you for the support you have shown to our office. You are the reason why we show up early and stay late. We take pride in our ability to deliver outstanding service in a safe, healing environment, while building relationships based on trust and integrity. We would be unable to accomplish our mission without your commitment to excellence in holding us to a higher standard. Many members of our office report how their life has changed in so many positive ways since they began visiting us. We figured it was time to let the secret out of the bag and share why it is that every member always leaves our office with a huge smile on his/her face. We are currently in the process of creating a binder entitled, “Our Members Speak”. We also have a great section on our website we like to post our victories. For those current members who would like to be included in this project, we are asking for a short contribution explaining your experiences with D.R.E.A.M. Wellness. Please feel free to be as specific or as general as you like. With your permission, your page will be included in the binder and placed on public display in our office for our other current and future D.R.E.A.M. Wellness members to read. We thank you for supporting D.R.E.A.M. Wellness and most importantly for committing to your health. I have read the above and wish to grant my permission for DREAM Wellness to use my story on their educational / marketing materials. I grant permision for DREAM Wellness to use my: (check all that apply)* First name and first letter of last name only Complete first and last name Photograph Typing your full name here will count as a signature in granting DREAM Wellness to use the information you permit us to above. Please list some or all of the conditions/symptoms (if any) you had when you first started care at DREAM Wellness. Include how long you had had these problems and what other health care providers have you been to prior to care here.What DREAM Wellness services did you utilize and how did they affect your health and lifestyle?Please explain your experience at this office during the course of your care.How did your family/friends/health care providers feel about you receiving these services?Include how many people you referred to DREAM Wellness and how much they have thanked you for it!Use this space to add anything else that you think people should know about your positive experience at DREAM Wellness. Δ