Patient Feedback Form

I am collecting feedback from patients about their experience of my practice to help me identify what is going well and areas needing improvement. I would be very grateful if you had a moment to complete this questionnaire.

Patient Feedback Questionnaire

Please confirm your gender *

Please confirm your age *

Was the osteopath polite and considerate? *

Did the osteopath listen to what you had to say? *

Did the osteopath give you enough opportunity to ask questions? *

Did the osteopath answer all your questions? *

Did the osteopath explain things in a way that you could understand? *

Are you involved as much as you want to be in the decisions about your care and treatment? *

Do you have confidence in the osteopath? *

Did the osteopath respect your views? *

If the osteopath examined you did they ask your permission? *

If the osteopath examined you did they respect your privacy and dignity? *

By the end of the consultation did you feel better able to understand and/or manage your condition and your care *

Overall, how satisfied were you with the osteopath that you saw? *

4 + 9 =

Any views you provide are entirely voluntary and anonymous. Your response to the survey will be taken as consent to participate and should only take a few minutes. The results will only ever be published in forms that cannot identify you as an individual. The collated results may be shared with my peer or others in order to help me discuss my practice and continuing professional development.

All data collected in this survey will be held securely and will be destroyed as soon as it is no longer required for analytical purposes and after no more than six years.