Patient Feedback Form

Patient Feedback Form

Your opinion matters! Take a few minutes to fill out our 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. Please be assured that any information you provide 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*

DayMonthYear
Why homeopathy?*
Please tell us what prompted you to visit a homeopath.
About your appointment *
Which clinic did you attend and who was your homeopath?
Please highlight each line in each table below indicating your opinion on the level of performance.

Making an appointment*

	Very poor	Poor	Adequate	Good	Excellent
We want it to be as easy as possible for you to make an appointment. How would you rate your experience of booking an appointment?

Luci Joan Lawless*

	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 about your experience of using homeopathy?*
About your experience
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.
Type a question
Appointments | 0203 640 5903 option 1 | bordersappointments@homeopathy-uk.org
Scottish Borders Homeopathy is a charitable clinic run by Homeopathy UK; registered charity (number 235900) Registered Charity No: SCO49515 – Scotland.| https://homeopathy-uk.org |
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