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GP Feedback Survey – Central London NHS Acupuncture Service
Blank Form (#3)
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Your Practice Details
The Belgravia Surgery
Belgrave Medical Centre
Victoria Medical Centre
Pimlico Health @ The Marven
Kings College Health Centre
Millbank Medical Centre
Dr Hickey Surgery
First Name
Last Name
Did you refer patients to the Acupuncture Clinic?
Yes
No
What kinds of conditions would you tend to refer to the Acupuncture Service?
What was the reason that you did not refer? (required)
I was not aware of the service
I did not know how to refer
Referral process was too cumbersome or unclear
I did not have patients who were suitable for Acupuncture treatment
I don't think Acupuncture is an effective treatment
Waiting times were too long
Other
Please Specify
Previous
Next
How would you rate the clinical benefit observed in patients who received acupuncture?
1 (No benefit)
2
3 (Some benefit)
4
5 (Significant benefit)
Did you observe improvements in any of the following for your patients after acupuncture treatment?
Pain levels
Mobility/function
Mental wellbeing
Reduced medication use
Do you believe acupuncture contributed to improved quality of life for your patients?
Yes
No
Not sure
Please explain briefly?
Did you find that acupuncture was particularly helpful with certain (types of) conditions? Please describe.
Were there (types of) conditions you found acupuncture was NOT helpful with? Please describe.
Any other comments on the clinical impact of acupuncture, based on your experience and observations?
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Next
Did acupuncture lead to a reduction in follow-up consultations for the same issue?
Yes
No
Not sure
Did you notice a reduction in prescriptions, imaging requests, or referrals to secondary care for these patients?
Yes
No
Not sure
If yes, please provide an example
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Next
How easy was it to refer patients to the acupuncture service?
1 (Very difficult)
2 (Somewhat difficult)
3 (Neutral)
4 (Easy)
5 (Very easy)
How could the referral process be improved?
Were the inclusion/exclusion criteria clear and appropriate?
Yes
No
If no, please comment
How satisfied were you with communication from the acupuncture team?
1 (Very satisfied)
2 (Satisfied)
3 (Neutral)
4 (Dissatisfied)
5 (Very dissatisfied)
Please comment
Previous
Next
What aspects of the service worked particularly well?
What improvements would you suggest for the service?
Would you support the continuation or expansion of the service?
Yes
No
Not sure
Please explain your response
Any other comments?
Can we contact you for further clarification on your experience?
No
Yes
Would you like to be informed when the Service Evaluation report is finished?
Yes
No
Your Email
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