Patient Feedback Form

We aim to provide all of our patients with the best possible service and your feedback plays a crucial part in helping us do this. All information will remain confidential - thank you for your time.

Your details (you may choose to keep your details confidential)

Name

First NameLast Name

Email

example@example.com

Date of appointment*

Why homeopathy?*

Please highlight (or circle) each line in each table below indicating your opinion on the level of performance.

Making an appointment*

	Very poor	Poor	Adequate	Good	Excellent
How would you rate your experience of booking an appointment?

Elaine Hamilton*

	Very poor	Poor	Adequate	Good	Excellent
Was polite, friendly and professional
Listened to me and let me ask questions
Checked that I was happy with planned treatments

Would you recommend the clinic to a friend? (Please tick a circle)*

YesNoUndecided

Has seeing a homeopath been beneficial to you?*

YesNoUndecided

Have you seen an improvement in your condition?*

YesNoUndecided

Is there anything else you would like to say about the practitioner or the consultation in general? *

We like to share patients’ experiences to help promote homeopathy to a wider audience. If you would be happy to tell your story, please email some brief information and your contact details to our Communications Manager - sam@homeopathy-uk.org.

Thank you for taking the time to complete this form – we really appreciate it.

Please press the submit button below to submit this form.

Appointments | 0203 640 5903 option 1| dumfriesgallowayapp@homeopathy-uk.org
Dumfries and Galloway Homeopathy is a charitable clinic run by Homeopathy UK in partnership with SHRET; we are a registered charity (number 235900) Registered Charity No: SCO49515 – Scotland.| https://homeopathy-uk.org |

Patient Feedback Form

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