Enhance Your Experience at Meridian Flow Survey

1. What prompted you to try acupuncture?

What prompted you to try acupuncture? Recommendation by Doctor, friend or family member

Last resort - had tried many other therapies without success

Prefer alternative therapies to drugs or surgery

Have had success with acupuncture in the past

Western medicine has no solution

Other (please specify)

2. How did you hear about Meridian Flow Acupuncture?

How did you hear about Meridian Flow Acupuncture? Friend/Family/Colleague

Health Practitioner (RMT, ND, GP etc)

Internet search

Sandwich board

Other (please specify)

3. How many acupuncture sessions have you had at Meridian Flow?

How many acupuncture sessions have you had at Meridian Flow? 1

2 - 6

7 - 12

13 - 20

more than 20

4. If you only had one acupuncture treatment why did you not return?

If you only had one acupuncture treatment why did you not return? Cost

Location is inconvenient

Hours are inconvenient

No change in condition

Adverse reaction to treatment

Disliked practitioner

Other (please specify)

5. If you stopped after 12 sessions or less what is/are the reason(s)?

If you stopped after 12 sessions or less what is/are the reason(s)? Condition improved

Condition worsened

No change in condition

Cost

Location is inconvenient

Hours are inconvenient

Disliked treatment approach

Conflict with practitioner

Other (please specify)

6. If you are continuing treatment on a regular basis what are your reasons?

If you are continuing treatment on a regular basis what are your reasons? Pain management

Alleviate stress/Relax

Cope with a chronic condition

Prevent illness/Strengthen immune system

Maintain certain level of health

Other (please specify)

7. Please rate the following statements

	Strongly disagree	Somewhat disagree	Neutral	Somewhat agree	Strongly agree
Acupuncture is beneficial for my condition	*Please rate the following statements Acupuncture is beneficial for my condition Strongly disagree	Acupuncture is beneficial for my condition Somewhat disagree	Acupuncture is beneficial for my condition Neutral	Acupuncture is beneficial for my condition Somewhat agree	Acupuncture is beneficial for my condition Strongly agree
Treatment rooms are calm and relaxing	Treatment rooms are calm and relaxing Strongly disagree	Treatment rooms are calm and relaxing Somewhat disagree	Treatment rooms are calm and relaxing Neutral	Treatment rooms are calm and relaxing Somewhat agree	Treatment rooms are calm and relaxing Strongly agree
Reception area is clean and comfortable	Reception area is clean and comfortable Strongly disagree	Reception area is clean and comfortable Somewhat disagree	Reception area is clean and comfortable Neutral	Reception area is clean and comfortable Somewhat agree	Reception area is clean and comfortable Strongly agree
Doctor has a warm and compassionate approach	Doctor has a warm and compassionate approach Strongly disagree	Doctor has a warm and compassionate approach Somewhat disagree	Doctor has a warm and compassionate approach Neutral	Doctor has a warm and compassionate approach Somewhat agree	Doctor has a warm and compassionate approach Strongly agree
Doctor answers questions regarding treatment in a clear and concise manner	Doctor answers questions regarding treatment in a clear and concise manner Strongly disagree	Doctor answers questions regarding treatment in a clear and concise manner Somewhat disagree	Doctor answers questions regarding treatment in a clear and concise manner Neutral	Doctor answers questions regarding treatment in a clear and concise manner Somewhat agree	Doctor answers questions regarding treatment in a clear and concise manner Strongly agree
Clients are well informed on treatment modalities, principles and options	Clients are well informed on treatment modalities, principles and options Strongly disagree	Clients are well informed on treatment modalities, principles and options Somewhat disagree	Clients are well informed on treatment modalities, principles and options Neutral	Clients are well informed on treatment modalities, principles and options Somewhat agree	Clients are well informed on treatment modalities, principles and options Strongly agree
Treatment is affordable	Treatment is affordable Strongly disagree	Treatment is affordable Somewhat disagree	Treatment is affordable Neutral	Treatment is affordable Somewhat agree	Treatment is affordable Strongly agree

8. Are you interested in materials related to patient education?

	Yes	No
General information on Acupuncture and Chinese medicine	*Are you interested in materials related to patient education? General information on Acupuncture and Chinese medicine Yes	General information on Acupuncture and Chinese medicine No
Acupuncture theory	Acupuncture theory Yes	Acupuncture theory No
How acupuncture works according to Western medicine	How acupuncture works according to Western medicine Yes	How acupuncture works according to Western medicine No
Studies on specific conditions	Studies on specific conditions Yes	Studies on specific conditions No
Information on other aspects of treatment such as cupping, moxa	Information on other aspects of treatment such as cupping, moxa Yes	Information on other aspects of treatment such as cupping, moxa No

Other (please specify)

9. Do you follow Meridian Flow Acupuncture on any social media sites?

	Yes	No
Facebook	Do you follow Meridian Flow Acupuncture on any social media sites? Facebook Yes	No
Twitter	Twitter Yes	No
Youtube	Youtube Yes	No
Blog	Blog Yes	No

10. Please enter your name and email address if you wish to be entered in the draw for a free acupuncture treatment.

Please enter your name and email address if you wish to be entered in the draw for a free acupuncture treatment. Name:
Email Address:

Enhance Your Experience at Meridian FlowExit this survey

1. What prompted you to try acupuncture?

2. How did you hear about Meridian Flow Acupuncture?

3. How many acupuncture sessions have you had at Meridian Flow?

4. If you only had one acupuncture treatment why did you not return?

5. If you stopped after 12 sessions or less what is/are the reason(s)?

6. If you are continuing treatment on a regular basis what are your reasons?

7. Please rate the following statements

8. Are you interested in materials related to patient education?

9. Do you follow Meridian Flow Acupuncture on any social media sites?

10. Please enter your name and email address if you wish to be entered in the draw for a free acupuncture treatment.

Enhance Your Experience at Meridian Flow
Exit this survey