Workshop Survey

Workshop title    
Spinal 
Nutritional 
Learning Disabilities 

Date attended  
Name:    
Email address:     
Phone No:   

1. Did you find this workshop helpful? 
Yes No  
2.What did you learn?  
3..Will this help you as a patient?  
Yes No  
4. How?  
5.How could we improve this workshop?  
6. Do you think others in our community would benefit from these workshops? 
Yes No  
7. Please list the names of those you know that would have benefitted from this talk and/or chiropractic care. 




8. Can we offer them a complimentary examination? 
Yes No  
9.Can we put them on our workshop mailing list? 
Yes No  
10. Can we call them or will you call them concerning this? 
Yes No  
11. Do you know of any group to which we can present a workshop? This can be a church, civic, fraternal club or in your home or at work. 

12. Which topics would interest you? 

Thank you for taking the time to fill out our survey.