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?

YesNoDon't KnowN/A

Was it easy to make an appointment?

YesNoDon't KnowN/A

Was there an appointment available to suit you?

YesNoDon't KnowN/A

Did you receive accurate directions to the Practice?

YesNoDon't KnowN/A

2. What were your main reasons for in attending Body Back-Up? (Tick box(es) that apply)

Pain ReliefExcersisesManipulationPostural checkMassageAdviceMaintenance treatmentReassuranceAn alternative to medicationInformation

If other please (specify)

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

YesNoUnsure

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

YesNoUnsure

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

YesNo

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

ExcellentGoodFairUnsatisfactory

Any further comments or suggestions


The Date:

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