WAKO Patient Satisfaction Survey 2026 Tratment Date DD slash MM slash YYYY Rate the change in how you feel now compared to before this treatment? -5 -4 -3 -2 -1 0 1 2 3 4 5 Global Perception of Change -5 = Much Worst 0 = No change 5 = Much BetterPlease take a moment to evaluate the following questions using the rating scale provided below:1. Very Unsatisfied / 2. Somewhat Unsatisfied / 3. Neutral / 4. Satisfied / 5. Very satisfiedMy chiropractor thoroughly explained the treatment(s) I received. N/A 0 1 2 3 4 5 My chiropractor treated me respectfully. N/A 0 1 2 3 4 5 My chiropractor answered all my questions. N/A 0 1 2 3 4 5 Overall, I am completely satisfied with the services I received from my chiropractor. N/A 0 1 2 3 4 5 I would return to FICS chiropractors for future services or care. N/A 0 1 2 3 4 5 Δ