Survey Survey "*" indicates required fields Name* First Last Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Which of the following payment methods did you use?*Insurance (ILWU, VA etc.)Non Profit (UMMA etc.)HSA / FSACash / CreditOther How did you hear about West Coast Sports & Fitness Center?*Social MediaReferral from a Friend/ Family MemberWord of MouthAdvertisementSearch Engine (Google, Bing etc.)OtherWhat brought you to our center?* What service(s) did you receive? (Check all that apply)* Chiropractic Care Acupuncture Massage Therapy Movement Therapy Stretch Therapy Exercise Training Body Fat Testing How would you rate the quality of our service(s)?ExcellentGoodAveragePoorVery PoorWould you recommend our services to a family member or friend?YesNoMaybeRate our customer service on a scale of 1 to 10, with 10 being the highest score.*Please enter a number from 0 to 10.What do you like most about our center?*How may we improve your experience?*NameThis field is for validation purposes and should be left unchanged.
