End of Treatment Questionnaire
Full Name *
DOB *
Are you a: *
Health screening questions for all patients:
On a scale of 1 - 5 please rate your level of Mobility (walking about) *
On a scale of 1 - 5 please rate your level of Self-Care (Washing & dressing) *
On a scale of 1 - 5 please rate your level normal activity (Work/Study/Home & Leisure) *
On a scale of 1 - 5 please rate your level of Pain/Discomfort *
On a scale of 1 - 5 please rate your level of Anxiety/Depress *
Please choose from the statements below:
I've been feeling optimistic about the future: *
I've been feeling useful: *
I've been feeling relaxed: *
I've been dealing with problems well: *
I've been thinking clearly *
I've been feeling close to other people: *
I've been able to make my mind up about things: *
What is your current work status(if applicable): *
Please rate your customer experience: *
Client Experience Survey:
Joints & Points Healthcare are keen to receive feedback and improve our service to you. Your time taken to complete the questions below are valuable to us and will be treated in confidence.
Select the service you received: *
Required
Please select your service location: *
Required
Was this the first time you used Joints & Points:
Clear selection
Have you been assessed and treated for this condition before elsewhere
Clear selection
Where the appointment times convenient for you?
Clear selection
Did you complete an initial consent form before you treatment?
Clear selection
Where you provided with an aftercare leaflet after your first session:
Clear selection
Was this information easy to understand:
Clear selection
Was this information relevant and helpful to your condition:
Clear selection
Was the booking process efficient and friendly:
Clear selection
I was satisfied with information prior to my visit:
Clear selection
The clinic was clean, accessible and comfortable:
Clear selection
My Clinician provided a thorough assessment and clear explanation:
Clear selection
Overall I was pleased with the quality of service I received?
Clear selection
Do you have any further comments?
If you have any further, confidential comments you would like to make then please call the Practice Manager on 0151 345 6823 or e-mail to info@jointsandpoints.co.uk
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