inputSchema: type: object properties: title: Chiropractic Survey pages: - id: 1 name: patient_information label: Patient Information hint: Optional identification type: note options: [] required: false - id: 2 name: patient_name label: Your Name hint: Optional type: text options: [] required: false - id: 3 name: visit_date label: Date of Last Visit hint: null type: date options: [] required: false - id: 4 name: number_of_visits label: How many times have you visited our office hint: null type: select_one options: - First visit - 2-5 visits - 6-10 visits - 11-20 visits - More than 20 visits required: false - id: 5 name: overall_experience label: Overall Experience hint: Your general impression type: note options: [] required: false - id: 6 name: overall_satisfaction label: Overall Satisfaction with Our Office hint: null type: select_one options: - Very Satisfied - Satisfied - Neutral - Dissatisfied - Very Dissatisfied required: true - id: 7 name: would_recommend label: Would you recommend our office to others hint: null type: select_one options: - Definitely yes - Probably yes - Not sure - Probably no - Definitely no required: true - id: 8 name: office_environment label: Office Environment hint: Facility and atmosphere type: note options: [] required: false - id: 9 name: office_cleanliness label: Office Cleanliness hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor required: true - id: 10 name: office_comfort label: Office Comfort and Atmosphere hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor required: true - id: 11 name: waiting_area label: Waiting Area Comfort hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor - Not applicable required: true - id: 12 name: staff_evaluation label: Staff Evaluation hint: Our team members type: note options: [] required: false - id: 13 name: front_desk_staff label: Front Desk Staff Friendliness hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor required: true - id: 14 name: front_desk_helpfulness label: Front Desk Staff Helpfulness hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor required: true - id: 15 name: assistant_staff label: Assistant Staff Professionalism hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor - Did not interact required: true - id: 16 name: billing_staff label: Billing Staff Helpfulness hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor - Did not interact required: true - id: 17 name: doctor_evaluation label: Doctor Evaluation hint: Your chiropractor type: note options: [] required: false - id: 18 name: doctor_listening label: Doctor's Ability to Listen hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor required: true - id: 19 name: doctor_explanation label: Doctor's Explanation of Treatment hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor required: true - id: 20 name: doctor_knowledge label: Doctor's Knowledge and Expertise hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor required: true - id: 21 name: doctor_bedside_manner label: Doctor's Bedside Manner hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor required: true - id: 22 name: treatment_effectiveness label: Treatment Effectiveness hint: Results achieved type: note options: [] required: false - id: 23 name: symptom_improvement label: Improvement in Symptoms hint: null type: select_one options: - Complete resolution - Significant improvement - Moderate improvement - Slight improvement - No improvement - Worse required: true - id: 24 name: treatment_met_expectations label: Did treatment meet your expectations hint: null type: select_one options: - Exceeded expectations - Met expectations - Partially met expectations - Did not meet expectations required: true - id: 25 name: pain_relief label: Level of Pain Relief hint: null type: select_one options: - Complete relief - Significant relief - Moderate relief - Slight relief - No relief required: true - id: 26 name: functional_improvement label: Improvement in Daily Function hint: Ability to perform activities type: select_one options: - Significant improvement - Moderate improvement - Slight improvement - No change - Worse required: true - id: 27 name: scheduling_access label: Scheduling and Access hint: Appointment process type: note options: [] required: false - id: 28 name: scheduling_ease label: Ease of Scheduling Appointments hint: null type: select_one options: - Very easy - Somewhat easy - Neutral - Somewhat difficult - Very difficult required: true - id: 29 name: wait_time label: Typical Wait Time hint: In the waiting room type: select_one options: - Less than 10 minutes - 10-20 minutes - 21-30 minutes - 31-45 minutes - More than 45 minutes required: true - id: 30 name: appointment_availability label: Availability of Preferred Appointment Times hint: null type: select_one options: - Always available - Usually available - Sometimes available - Rarely available - Never available required: true - id: 31 name: value_assessment label: Value Assessment hint: Cost and value type: note options: [] required: false - id: 32 name: value_for_money label: Value for Money hint: null type: select_one options: - Excellent value - Good value - Fair value - Poor value - Very poor value required: true - id: 33 name: insurance_handling label: Insurance Claims Handling hint: null type: select_one options: - Excellent - Very Good - Good - Fair - Poor - Not applicable required: true - id: 34 name: additional_services label: Additional Services hint: Other offerings type: note options: [] required: false - id: 35 name: interested_services label: What additional services would interest you hint: Select all that apply type: select_multiple options: - Massage therapy - Physical therapy - Nutritional counseling - Wellness programs - Exercise classes - Stress management - Weight loss programs - None - Other required: false - id: 36 name: open_feedback label: Open Feedback hint: Your comments type: note options: [] required: false - id: 37 name: what_liked_most label: What did you like most about our office hint: null type: text options: [] required: false - id: 38 name: what_needs_improvement label: What areas need improvement hint: Your suggestions type: text options: [] required: false - id: 39 name: additional_comments label: Any Additional Comments hint: We value your feedback type: text options: [] required: false - id: 40 name: follow_up_permission label: May we contact you about your feedback hint: null type: select_one options: - 'True' - 'False' required: false