Chester County Herbs and Acupuncture Complementary and Alternative Medicine, Advantage or Disadvantage? Question Title * 1. Age? Under 25 Over 25 Question Title * 2. Gender? Male Female Transgender Question Title * 3. Race? American Indian or Alaskan Native Asian Black or African American Latino/Hispanic Native Hawaiian or Pacific Islander White Two or more races Question Title * 4. Marital Status? Single Married/Remarried Separated Divorced/Widowed Question Title * 5. Reglious Affilation? Buddhist Catholic Jewish Hindu Muslim Non-denominational Christian Protestant Shinto Other None Question Title * 6. Household Income? Under $30,000 $30,000- $40,000 $40,000-$50,000 $50,000-$60,000 $60,000 or more Question Title * 7. Medical Diagnosis (optional) Question Title * 8. How did you hear about Chester County Herbs and Acupuncture? Friend Family member Medical Physician Other Question Title * 9. What prompted you to come to Chester County Herbs and Acupuncture? Question Title * 10. How often do you currently use Chester County Herbs and Acupuncture services? Extremely often Very often Moderately often Slightly often Not at all Explain why (optional) Question Title * 11. How many treatments do you need to get results? 0 1 2 3 4 5 or more Question Title * 12. How many conventional medical practitioners did you see for the issue that brought you to CCHA? 0 1 2 3 4 5 or more Question Title * 13. What complementary and alternative (CAM) practitioners have you seen? (May choose more than one) Chiropractor Acupuncturist Traditional Chinese Medicine (TCM) Homeopathy Naturopathy Other Question Title * 14. How many CAM practitioners did you see for the issue before coming to CCHA? 0 1 2 3 4 5 or more Question Title * 15. How often do you receive treatments? Weekly Bi-weekly Monthly Other Question Title * 16. Do you see any benefits from the treatments at CCHA? Yes No Not sure If yes, please state below (optional) Question Title * 17. How many treatments before you noticed results? 0 1 2 3 4 5 or more Question Title * 18. How likely would you be to recommend these services to a friend or colleague? Not at all likely0 1 2 3 4 5 6 7 8 9 Extremely likely10 Not at all likely0 1 2 3 4 5 6 7 8 9 Extremely likely10 Question Title * 19. When you think about these services/treatments, do you think of it as something people might NEED or as something people might WANT? Need Want Both equally Question Title * 20. How long have you been using CAM or the services that CCHA provides? 0-2 years 3-5 years 6-8 years 9 or more years Question Title * 21. What do you like best about this facility and what they offer? Question Title * 22. What do you like least about this facility and what they offer? Question Title * 23. What services do you use? (More than one may be selected) Acupuncture Herbal Medicine Cupping Moxibustion Manual Therpies Muscle Meridian Balancing Question Title * 24. If you no longer come to receive treatments, why don’t you? Question Title * 25. On a scale of 0-5 (0 not at all- 5 extremely) rate the following words that describe your experience at CCHA? 0 1 2 3 4 5 Effective Effective 0 Effective 1 Effective 2 Effective 3 Effective 4 Effective 5 Affordable Affordable 0 Affordable 1 Affordable 2 Affordable 3 Affordable 4 Affordable 5 Safe Safe 0 Safe 1 Safe 2 Safe 3 Safe 4 Safe 5 Healing Healing 0 Healing 1 Healing 2 Healing 3 Healing 4 Healing 5 Convenient Convenient 0 Convenient 1 Convenient 2 Convenient 3 Convenient 4 Convenient 5 Painful Painful 0 Painful 1 Painful 2 Painful 3 Painful 4 Painful 5 Professional Professional 0 Professional 1 Professional 2 Professional 3 Professional 4 Professional 5 Front desk staff helpful? Front desk staff helpful? 0 Front desk staff helpful? 1 Front desk staff helpful? 2 Front desk staff helpful? 3 Front desk staff helpful? 4 Front desk staff helpful? 5 Treatments good value? Treatments good value? 0 Treatments good value? 1 Treatments good value? 2 Treatments good value? 3 Treatments good value? 4 Treatments good value? 5 Location convenient? Location convenient? 0 Location convenient? 1 Location convenient? 2 Location convenient? 3 Location convenient? 4 Location convenient? 5 Are the treatments affordable? Are the treatments affordable? 0 Are the treatments affordable? 1 Are the treatments affordable? 2 Are the treatments affordable? 3 Are the treatments affordable? 4 Are the treatments affordable? 5 Question Title * 26. Who were you treated by? Margaret Sheehan, L.Ac Greg DelCollo, L.Ac Both Margaret and Greg Question Title * 27. How would you describe your treatment provider(s)? 0 1 2 3 4 5 Professional Professional 0 Professional 1 Professional 2 Professional 3 Professional 4 Professional 5 Kind Kind 0 Kind 1 Kind 2 Kind 3 Kind 4 Kind 5 Good Listener Good Listener 0 Good Listener 1 Good Listener 2 Good Listener 3 Good Listener 4 Good Listener 5 Indifferent Indifferent 0 Indifferent 1 Indifferent 2 Indifferent 3 Indifferent 4 Indifferent 5 Careless Careless 0 Careless 1 Careless 2 Careless 3 Careless 4 Careless 5 Prompt Prompt 0 Prompt 1 Prompt 2 Prompt 3 Prompt 4 Prompt 5 Effective Effective 0 Effective 1 Effective 2 Effective 3 Effective 4 Effective 5 Question Title * 28. How well does the word INNOVATIVE describe CCHA? Extremely well Very well Moderate Slightly well Not at all Question Title * 29. Would you be available for an in-person (or telephone) interview, to help us gather more information about our services and how they are perceived? Yes No Question Title * 30. Any questions, comments or concerns? Please contact Bonnie at BonnieRubin@ymail.com for an interview. Done