Patient Feedback Form

Thank you for taking the time to provide feedback on your consultation. Your insights are essential to help us improve our services.

Your feedback will be anonymous unless you wish to provide your details.

Name

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Section 1 - Scoring Feedback

Please rate the following aspects of the service on a scale of 1 to 10, where 1 is Poor and 10 is Excellent

Quality of medical advice provided

Selected Value: 1

Communication skills of the prescriber

Selected Value: 1

Responsiveness to your questions and concerns

Selected Value: 1

Overall score of service

Selected Value: 1

Were your communication needs (e.g., language, understanding) adequately met?

Does the consultant make you feel comfortable and respected your dignity and confidentiality?

Does the consultant introduce themselves and explain their role?

Treatment and Decision Making

Selected Value: 1

Were the treatment options explained clearly, including risks and benefits? Were your preferences and values considered in the decision-making process? Did you feel involved in making decisions about your treatment?

Follow-Up and Support

Selected Value: 1

Did the consultant discuss a plan for monitoring your treatment and scheduling follow-ups? Were you given clear instructions on how to contact the consultant if needed?

How likely are you to recommend our consultation service to others?

Selected Value: 1

Overall Satisfaction of Experience

Selected Value: 1

Section 2 -Additional Feedback

What did you find most helpful about the service? *

Is there anything that could have been improved? *

Any additional comments or suggestions: *

Section 3 - Future Services (you can skip this section)

Below are potentially future services to be offered as we look to expand services. Please rate the below out of 10 for interest. Feel free to add other ideas.

Bollywood Zumba

Selected Value: 1

I'm excited to explore launching online Bollywood dance classes designed to bring joy, fitness, and family fun—all for just £2.50 per session! Whether you want to dance solo, with a partner, or even get the kids involved, these sessions are for everyone.

Yoga - Hatha, Asthanga and Raja

Selected Value: 1

We’re exploring interest in yoga programs that combine traditional practices with modern research-backed benefits. The plan is to develop classes and pricing models that best meet your needs.

Personality Test to Motivate

Selected Value: 1

Using the MBTI assessment in an interactive manner which will then be used to tailor motivation strategies to achieve long-term weight loss goals.

Blood Test related to Weight Markers

Selected Value: 1

There are no current requirements to attend a blood test whilst on weight loss medication. However, there can be over 20 markers which can be used to assess obesity including 10 markers that are not routinely tested by NHS.

Please provide any other suggestions

Would you be happy to be contacted about any of the services?

Date Filled In *