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SATISFACTION SURVEY

Thank you for partnering with us to improve your well-being. We would like a few moments of time to ask you some questions to help us serve you better.

Name*
First Last
Email*
What treatment(s) did you have?*
Please rate the following based on your experience: (5 star=Excellent, 1 star=Not good)
Ease of scheduling appointment*
ExcellentPretty goodNeutralNot so greatTerrible
Office environment, cleanliness, friendliness of staff*
ExcellentPretty goodNeutralNot so greatTerrible
Overall satisfaction with your provider (How well the provider listened, answered questions & time spent during visit)*
ExcellentPretty goodNeutralNot so greatTerrible
Satisfaction with results of your treatment?*
ExcellentPretty goodNeutralNot so greatTerrible
How likely are you to recommend Delaware Integrative Medicine to family and friends?*
Very likelySomewhat likelyNeutralSomewhat unlikelyVery unlikely
Level of trust in provider's decisions?*
ExcellentPretty goodNeutralNot so greatTerrible
How well provider listens and answers questions?*
ExcellentPretty goodNeutralNot so greatTerrible
Spends appropriate amount of time with patients?*
ExcellentPretty goodNeutralNot so greatTerrible
Fairness of price?*
ExcellentPretty goodNeutralNot so greatTerrible
Overall experience?*
ExcellentPretty goodNeutralNot so greatTerrible
What was your favorite part of your treatment?
How did you find us?*
- Online search engine
- News article
- Seminar
- Website
- Social media (Facebook, Twitter, Pinterest, etc.)
- Referred by a friend
Did you experience any problems, have suggestions, or other comments?
May we post your review public?*
- Yes
- Yes, but only use my initials
- No, I would prefer my review remain private
Would you like to subscribe to our newsletter?*
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- No
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ABOUT US

Dr. Childers is here to help you navigate to new levels of health and wellness by stimulating healing with non-surgical treatments, identifying, addressing, and treating indications of pain and chronic pain factors.

*Please note, insurance is not accepted.

20930 Dupont Blvd. Suite 203 Georgetown, DE 19947

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302-258-8853

302-487-0583 fax

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Please rate the following based on your experience: (5 star=Excellent, 1 star=Not good)

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