Complementary Therapy Evaluation Thank you for taking a few minutes to complete the following evaluation form. Your feedback will help us get a better understanding of whether complementary therapies are helpful and if so why Please note the form is better viewed on a tablet or PC/Laptop rather than a Mobile device. Complementary Therapies Evaluation Form Thank you for taking the time to complete our evaluation form for your recent complementary therapy sessions. It is very important that you enter the unique Therapy evaluation ID we sent you via email in the field below, to help us log your form correctly. Therapy evaluation ID Please use the unique Therapy ID sent to you in our email. Please use the format "T-000001" Personal details First Name Last Name Contact Phone Whichever is your preferred number Contact Email Complementary Therapy details Type of Complementary TherapyPlease select... Acupuncture Cranial Osteopathy Reflexology Date of first session Date of final session Question 1 Below is a list of possible after effects. Please select your score after 10 sessions of complementary therapy N/A 1 (mild) 2 3 4 5 (severe) Exhaustion Headaches Memory loss Anxiety Depression Dizzy/balance problems Hearing difficulties Other (please give details) Other possible after effects Question 2 Did Complementary therapy meet your expectations?YesNoExceeded Can you please explain how the complementary therapy meet your expectations Question 3 Would you consider continuing to use complementary therapies in the future? Sharing your story From time to time we appreciate being able to share the benefit you have felt from counselling after meningitis. Would you be willing to share your experience, eg case study, evaluation in our publications and on social media Yes I give permission Need assistance with this form?