* 1. Thank you for participating in this survey regarding the impact dry needling has had on your medical care.  We appreciate your willingness to help us collect data that will help to improve access to dry needling in patient care in the future.

No contact information is required to complete this survey.
Results will only be used anonymously even if contact information is provided. Contact information will only be used to allow interested individuals to contribute to activities relevant to a clinicians' utilization of Dry Needling in the United States upon future follow-up. By providing contact information you are authorizing KinetaCore to contact you in regard to Dry Needling.

* 2. Are you male or female?

* 3. What is your age?

* 4. What is the highest level of education you have completed or the highest degree you have received?

* 5. Which of the following categories best describes your employment status?

* 6. What is your ethnicity? (Please select all that apply.)

* 7. How likely is it that you would recommend Dry Needling to a friend or colleague?


* 8. When did you first receive Dry Needling (DN)?

1990 2003
i We adjusted the number you entered based on the slider’s scale.

* 9. How long has it been since you last received Dry Needling from a Physical Therapist?

* 10. For how many different problems or symptoms have you received Dry Needling?  Note:  For one problem you may have received multiple treatment sessions, while different problems would include either treatment in a different body region, or two different episodes of care.

* 11. Approximately how many total sessions of DN have you received?  This includes all the different body regions and episodes of care that you have received.  

* 12. Approximately how many filiments/needles were used, on average, per session by your PT?  A session would include treatment that occurred on a single day.

* 13. To which of the following body regions have you received Dry Needling? Select all that apply.

* 14. Do you feel that the Dry Needling benefitted you as part of your care?  Please only answer one option.

* 15. How do you view the effects of the inclusion of Dry Needling in your care?  Was your recovery time reduced, or DN had no perceptible effect, or it prolonged the length of your rehabilitation?  (Please select only one option.)

* 16. Based upon your answer to Q15 about whether DN had an effect on your care, please indicate to what extent DN impacted your overall response on a 0-100 scale.   0 = no effect on my care, 100 = every effect on my care was due to the Dry Needling.

0 50
i We adjusted the number you entered based on the slider’s scale.

* 17. Did you suffer any side effects from receiving Dry Needling? Please check each of the following that apply. The next question will allow you to list the number of occurrences.

* 18. If you listed any side effects from your Dry Needling, did the side effects you listed prevent you from a positive overall treatment experience?

* 19. Do you feel that your clinician properly educated you with regard to the benefits, risks and possible side effects of Dry Needling?

* 20. To what extent did the inclusion of dry needling impact your overall improvement while participating in physical therapy?  (0-100% impact)

0 50
i We adjusted the number you entered based on the slider’s scale.

* 21. Did your clinician use DN for pain control, to improve your function or both?  Please select only one answer.

* 22. Would you recommend Dry Needling to friends and family for people with physical impairment and or pain?

* 23. What type of practitioner performed Dry Needling in your clinical care?

* 24. Did a physician or other referral source recommend you to receive Dry Needling as part of your healthcare?

* 25. Did the inclusion of Dry Needling in your medical care change your medication use for pain or functional limitation for which you were receiving treatment?

* 26. For each unique problem that you received Dry Needling, after how many treatment sessions did you notice the biggest total change (negative or positive)?  Please select one number and include in the comment box which problem treated to which it relates.

* 27. Thank you for taking our survey!  Would you like to be contacted for any reason?  If so, please indicate your preferred method of contact (email, phone, etc).