Welcome to Body Back-Up - News & Feedback - Aftercare Questionaire

Aftercare Questionaire
Dear Patient,
We would appreciate a few minutes of your time to help us improve our patient care by answering a few questions about your recent treatment experience at Body Back-Up.

1. How did you hear about Body Back-Up?
Advert
Leaflet
YP
Website
Online Directory
Ins Co
Cons Ref
Pt Rec
GP Ref
GP Reception
Other
(If selected 'Other' please specify)

2. Have you received any of the following in relation to your current symptoms prior to attending Body Back-Up? (Tick box(es) that apply)
No previous treatment
X-Rays/MRI/CT Scan
Physiotherapy
Homeopathy
Chiropractic treatment
Acupuncture
GP Consultation
Blood Tests
Orthopaedic Consultation
Prescribed Medication

3. Tick the box that most reflects how you feel about the following:
Yes
No
Don't Know
N/A
Were the Receptionists helpful in answering your questions?
Was it easy to make an appointment?
Was there an appointment available to suit you?
Did you receive accurate directions to the Practice?

4. What were you looking for in attending Body Back-Up? (Tick box(es) that apply)
Pain Relief
Excersises
Manipulation
Postural check
Massage
Advice
Maintenance treatment
Reassurance
An alternative to medication
Information
Other (specify)

5. Do you feel you have been given sufficient information by your Osteopath?
Yes
No
Unsure

6. Are you happy with your treatment progression so far?
Yes
No
Unsure

7. Would you find a "6-month" check-up useful to keep you in good shape in future?
Yes
No

8. Were you aware that Osteopathy can help the following: (Tick boxes(es) thats apply)
Sciatica
Frozen Shoulder
Tennis/Golfers elbow
Whiplash

9. Were you aware that Osteopaths treat: (Tick box(es) that apply)
Pregnant Women
Children
Sports Injuries
Work related pain
Work Injuries

10. Who would you feel happy to recommend your Body Back-Up Osteopath to:
(Tick boxes(es) thats apply)
Friends
Colleagues
Relations
Would not reccomend

11. Did you find our website www.bodybackup.co.uk a useful source of information?
Yes
No

12. How do you rate your overall Body Back-Up experience?
Excellent
Good
Fair
Unsatisfactory

Any further comments or suggestions
Patients Name:
Email Address*:
Date:
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Maidenhead & Slough - 01628 624544 London W9 (Maida Vale) - 020 8969 0247
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