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Practice Improvement Survey

Dear Patient,

After 20 years in private practice I continue to strive to improve the quality of my services. Because of my on-going desire for high standards in alternative medical care, I would sincerely appreciate helping me "zero" in on the weaknesses and strengths of my services. I also want to know a little about you. The following questions have been carefully selected to allow me the opportunity to make the appropriate changes in my office. I thank you very much for your kind support and assistance.

1. List the health condition(s)/problem(s) that prompted you to consult with me

1A. How would you rate your treatment?  Poor Fair Good Excellent

2: Did the treatment protocol help?     YesNo

2. What is your age and gender?          Female Male

3. Married   Single Divorced Widowed

4. What is your occupation?

5. What are your favorite hobbies?

6. What magazines do you enjoy reading?

7. Do you read the Greenville News? Yes  No

8. What television channels do you frequently watch?

9. What radio station do you listen to?

10. How did you hear about my practice?

11. What is your zip code?

IMPORTANT QUESTIONS ABOUT MY PRACTICE AND THE FUTURE OF MY STUDIES

12. What would you say is different/unique about my practice? Is there anything that sets it apart from other chiropractors?

13: In the changing world of medicine, I have decided to take a new path and focus my energy and attention on functional diagnostic medicine. What is your understanding of functional medicine and how does it differ from the way traditional medicine is practiced?

14: In conversions with patients over the years, I have seen a growing frustration with the way patients are being managed by their primary physicians. Can you elaborate on some of the frustrations people are facing with their medical care? What do you look for in a doctor? What are some things that you dislike and wish would change?

15. I am presently completing my Master's degree in Nutritional Biochemistry. I am also finishing my Board Certification in Internal Diagnostic Medicine. I have already completed 210 hours of the 360 hour Diplomate program. What is your understanding of my studies and how will it impact you and other people in the community?

16: As in many traditional retail businesses, health services, churches, there is a Silent Majority who dislike something about their favorite restaurant, the way the church is running the children's ministry, the way their doctor's office bills patients... just to name a few. This Silent Majority refuse to "rock the boat" and will continue to frequent their favorite restaurant, their church, their doctor,.. etc.. even if their personal frustrations are not addressed. Unfortunately, the owner of the restaurant, the pastor/church staff and doctor may be totally unaware.. "blinded"  as it is sometimes called about these problems. I have discovered that a good percentage of people would be happy to offer their insight and suggestions about problems, dislikes, frustrations.. if and only if they could do it Anonymously.. privately.. without be known ..etc.. With your permission, I would like for your "gut-level" truth about my practice.. Tell it like it is... What don't you like? What turns you off?? Your sincere input will play a major role in helping me help you. I thank you ahead of time for your bluntness and honesty.

17: I would like your help in re-naming my practice. With many people seeking the advice of physicians practicing alternative/complementary/integrative medicine, I want to position my practice as not only providing alternative medical advice but also as a pivotal reference point for patients who do need traditional medical treatment. The following name changes are being considered. Please select the name that you find represents not only your understanding but would have the greatest acceptance in our changing medical system.

The Grisanti Center for Integrative Medicine

The Grisanti Alternative Medicine Center

Other: If you have any suggestions.. please let me know in the box below

18: For the past 2 years I have been developing my website adding close to 400 pages of content. I strive to write 3-4 new articles every 4-8 weeks. My goal is to have my site be used as an information center. With the current event of some of the major changes in medical science, I am consistently working on staying abreast of this information and pass it on to my subscribers and readers. I would like to know if you have read some of my articles called "The Grisanti Report?" Have you seen the changes on my website? www.drgrisant.com  If you answered yes.. to these questions.. and have found the information of benefit.. I would like to ask a favor of you. I want to let others know that they can find quality alternative medical information on my site as well as from "The Grisanti Report" and would be very appreciative if you would be open to providing the e-mails and names of three friends, family etc.. who you know would be interested in receiving this information. As always, your e-mail referrals will not be sold or used for any form of outside marketing. Your e-mail referrals will have the ability to have their name removed in the event they want to discontinue their FREE subscription. Again thank you. If you do not want to provide the names and e-mails of friends and family, I will understand. I simply thank you for listening.

1: Name E-mail

2: Name E-mail

3: Name E-mail

Please mark which conditions you would be most interested in learning more about.

Poor Circulation  

Flu/Colds

Cold Sores

Colitis

Menstrual Cramps

Crohn’s Disease

Depression

Diabetes

Constipation

Diarrhea 

Eczema/Psoriasis

Endometriosis 

Fatigue 

Fibrocystic Breast Disease

Fibroids

Fibromyalgia

Anal Fissure/Hemorrhoids

Gallstones

Hay fever

Headaches/Migraines

Heart Burn/Acid Reflux

Hepatitis

Herpes

Hives

Hot Flashes 

Hyper/Hypo Thyroidism

Indigestion

Infertility

Insomnia

Irritable Bowel Syndrome

Kidney Stones

Menopause

Menstrual Cramping

Multiple Sclerosis

Osteoporosis

Obesity/Weight Loss

Ovarian Cyst 

Parkinson’s Disease

PMS

Prostate Enlargement

Rheumatoid Arthritis

Seizures

Shingles

Skin Cancer 

Smoking Addiction

Stroke

Tinnitis

Ulcers

Urinary Tract Infections

Varicose Veins

Other

Other

Other