Family Chiropractic & Acupuncture

Directions

Name (optional)
Which type of treatment are you or have you received in the office?*

Chiropractic, Acupuncture, Massage or a combination of any of these
How would you rate your healthcare in our facility?*
- Poor
- Below Average
- Average
- Above Average
- Exceptional
How would you rate your experience with regards to customer service with the office staff?*
- Poor
- Below Average
- Average
- Above Average
- Exceptional
How would you rate the facilities in which you are receiving treatment?*
- Poor
- Below Average
- Average
- Above Average
- Exceptional
Additional information
Please feel free to expand upon any of the answers given above to let us know we may improve.
In which office have you received your treatment?*
- Western Branch (Chesapeake
- Other

Dr. Adam J. Keefe

Dr. Sara Miller

5800 High Street West
Portsmouth, VA 23703
Phone: (757) 686-3716

Leave This Blank:Leave This Blank Too:Do Not Change This:

Your email: