JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
ESO Clinic: Patient Feedback
This survey will take no more than a few minutes to complete. Thank you for your time.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
When making your first booking, did we explain fully and clearly what would happen on your first visit?
Extremely clear
Clear
Neither clear nor unclear
Unclear
No information offered
Clear selection
Did the student practitioner explain fully and clearly what they were doing during the initial consultation?
Yes
No
Clear selection
Did the student practitioner explain fully and clearly what they were doing during the follow up consultation?
Yes
No
Clear selection
Did the student practitioner enquire about your lifestyle, hobbies and daily activities in the consultation?
Yes
No
Clear selection
Were you asked about your goals and expectations?
Yes
No
Clear selection
Was verbal consent sought by the student practitioner prior to examination and treatment procedures?
Yes
No
Clear selection
Did the student practitioner discuss with you alternative approaches to treatment other than osteopathy?
Yes
No
Not applicable
Clear selection
Please rate the clarity of your student practitioner's explanation of their findings and their proposed treatment plan for you
Outstanding
Good
Adequate
Needs improvement
Poor
Not applicable
Clear selection
Did you feel involved in the decision-making process for your treatment?
Yes
No
Clear selection
Did the student practitioner clearly explain any risks associated with treatment?
Yes
No
Clear selection
Were you given post-treatment aftercare advice by the student practitioner? (i.e. exercises, cold packs, sleeping positions, posture or general health advice)
Yes
No
Not applicable
Clear selection
Did you feel respected throughout your consultation?
Yes
No
Clear selection
Did you feel that the Clinic Tutor supervision and support was appropriate?
Yes
No
Clear selection
Would you like to discuss any specific concerns with a member of the Clinic Management Team?
Yes
No
Clear selection
If 'yes', please provide your contact details
(
full name, email address and telephone number
)
and a member of the Clinic Management Team will be in contact
Your answer
Would you like to be a member of our Patient Experience Group?
The group meets 4 times per year, for 1 hour
Yes
No
Maybe later on
Clear selection
If 'yes', please provide your contact details
(
full name, email address and telephone number
)
and a member of the Clinic Management Team will be in contact
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of clinic.eso's Workspace.
Report Abuse
Forms
