1. Fertility Acupuncture Feedback

An opportunity for you to feedback your experience of Fertility Acupuncture. Thank you! Feedback from you is so helpful for others when trying to decide whether or not to have acupuncture to help with fertility problems. It's also great to hear your views. Please be aware that your views may be shared as testimonials on my website of Facebook page 'devon fertility acupuncture'. If you wish to remain anonymous please tick 'anonymous' in question 10 on this survey. Thank you for your time. 

* 1. What is your Name and How old were you when you had Acupuncture Treatment?

* 2. Where do you live?

* 3. When you came to have Acupuncture to help with fertility was it for your first child or second or more? Was the acupuncture to support IVF / ICSI or as a stand alone treatment? Please mark the appropriate boxes.

  First IVF Second IVF Third IVF ICSI Natural Fertility
First Child
Second Child
Third Child

* 4. Was it just you (please indicate male / female) having treatment or did your partner also have treatment? Please could you fill in who had treatment and whether or not you had Chinese Herbs as well. Please could you also fill in for how long (approximately) you each had acupuncture sessions.

  One session only Between two and six sessions Between seven and twelve sessions Between twelve and twenty four sessions More than twenty four sessions
Acupuncture for Male only
Acupuncture for Female only
Acupuncture for Both Partners
Acu & Herbs for Male only
Acu & Herbs for Female only
Acu & Herbs for Both Partners

* 5. Please can you describe what you were looking to get out of treatment:

* 6. How did you benefit from treatment?

* 7. Were there any side effects that you experienced from your Acupuncture treatment or from taking the Chinese Herbs? - (side effects could be good or bad)..

* 8. How was your overall experience of Fertility Treatment affected by having Acupuncture / Taking Chinese Herbs?

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

* 10. Would you be happy for me to use any of your comments for promotional purposes either on the website or on my acupuncture Facebook pages as testimonials?

 
Yes with full name and occupation
Yes with first name and occupation
Yes with just first name
Yes with just occupation
Yes as anonymous
No, I'd rather not. 
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