Follow-Up and Feedback
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Email *
How many days has it been since your last visit? *
Since your visit, how has the following changed during your daily activities? *
Markedly Worse
Slightly Worse
Unchanged
Slightly Better
Markedly Better
Pain
Your ability to breathe comfortably
Your ability to move around (e.g., changing positions, walking)
Your ability to perform tasks in your daily life
My mental outlook
Please rate the following statements.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Dr. Werner listened to and understood my concerns.
Dr. Werner addressed my concerns.
I feel comfortable with the next steps I should take in order to improve my health.
I would recommend Family Osteopathy to my friends or family.
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What additional feedback would you like to share with us? This could include testimonials to share with future patients.
Would you like to be contacted to schedule your next appointment? *
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