1. Name

2. Name of Therapist

3. How easy was it to book your appointment?

Very easy Easy Neutral Difficult Very difficult

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4. Were you satisfied with the time you had to wait for your appointment?

Yes, very satisfied Somewhat satisfied Neutral Somewhat dissatisfied Very dissatisfied

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5. How would you rate the professionalism of the healthcare staff you interacted with?

Excellent Good Average Poor Very poor

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6. How clearly did the healthcare staff explain your condition and treatment options?

Very clearly Somewhat clearly Neutral Somewhat unclearly Very unclearly

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7. Did you feel involved in decisions about your care?

Yes, completely Somewhat Neutral Not much Not at all

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8. Overall, how was your experience of our service?

Very good Good Neither good nor poor Poor Very poor Don't know

9. Where did your appointments take place?

MCH House Ourzone Rochester Health Living Centre Parkwood Healthy Living Centre Lordswood Health Living Centre Walter Brice Centre Meads Medical Practice OM Medical Practice Telephone appointment Other Unsure

10. Was the location of your appointment convenient for you?

Yes, very convenient Somewhat convenient Neutral Not very convenient Not at all convenient

11. How would you rate the cleanliness and comfort of the facilities?

Excellent Good Average Poor Very poor

12. What did you like about our service?

13. Is there anything we could improve on?

Yes No

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14. Are you?

Male Female Non-binary Prefer not to say

15. Age?

Under 18 18-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Prefer not to say

16. Ethnicity: Are you?

White Mixed or multiple ethnic groups Asian or British Asian Black, Black British, Caribbean or African Other ethnic group Prefer not to say