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Acupuncture Survey

1. Acupuncture Survey

A Short Questionnaire to gain feedback about people's experience of Acupuncture Treatment

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* 1. What is your name and how old are you?

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* 2. Where do you live?

Name:

Address:

Address 2:

City/Town:

State:

ZIP/Postal Code:

Email Address:

Phone Number:

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* 3. Please describe what you came to have Acupuncture for:

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* 4. How did you benefit from treatment?

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* 5. How would you describe your overall experience of having Acupuncture with Nicola?

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* 6. Did you experience any side effects to Acupuncture treatment?

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* 7. Please could you describe what you expected from Acupuncture treatment and whether the actual experience differed from your expectations in any way:

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* 8. How long ago was your last session, and how are the problems now that you first came to have treatment for?

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* 9. What did you value most about coming for Acupuncture Treatment?

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* 10. Would you recommend Acupuncture with Nicola to anyone? If so, please can you say who you would recommend it to and why: