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.

Contact Details - Optional

Your Name:
Your Email:

1. Tick the box that most reflects how you feel about the following:

Were the Receptionists helpful in answering your questions?

 Yes No Don't Know N/A

Was it easy to make an appointment?

 Yes No Don't Know N/A

Was there an appointment available to suit you?

 Yes No Don't Know N/A

Did you receive accurate directions to the Practice?

 Yes No Don't Know N/A

2. What were your main reasons 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

If other please (specify)

3. Do you feel you have been given sufficient information by your Osteopath?

 Yes No Unsure

4. Are you happy with your treatment progression so far?

 Yes No Unsure

5. Would you find a "6-month" check-up useful to keep you in good shape in future?

 Yes No

6. How do you rate your overall Body Back-Up experience?

 Excellent Good Fair Unsatisfactory

Any further comments or suggestions

The Date:

 Please Tick if you wish to not be contacted about future offers or promotions.

To Submit Your form please enter the letters/numbers below and press submit, thank you.


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             Osteopathy – Kailash Centre

        Robin Lansman D.O.  

 Standard Consultation       Robin Lansman D.O. 45 Mins

60 Mins