The experiences of 500 consecutive patients presenting with a new episode of illness at a five practitioner osteopathic practice in an east midlands town is reported. The osteopath completed a structured questionnaire about each patient who then completed two symptom questionnaires, one before treatment and a second four months later. Questionnaires were completed by osteopaths for 495 patients (99.0%). Almost all patients completed the first questionnaire (98.6%) and 367 patients (73.4%) completed the second questionnaire. Female patients had more treatment sessions than male patients (3.2 versus 2.7 over the four month period, P < 0.01) and suffered from more spinal muscular problems and postural imbalance than males (P < 0.05). The commonest diagnostic group was spinal joint sprain and patients with this diagnosis reported significantly better symptom improvement at four months than those in other diagnostic groups. Greater improvement at four months was also associated with shorter duration of illness before treatment (P < 0.001). The 147 patients who had seen their general practitioner before attending the osteopath had worse symptoms of a longer duration than the 347 patients who had not seen their general practitioner (P < 0.001), but showed greater improvement in symptoms over the subsequent four months. It is concluded that suitable patients should be encouraged to attend an osteopath early on in an illness. In subsequent episodes, if osteopathic treatment is of benefit to them, patients should attend before they see their general practitioner.