Acle Medical Partnership

Dear Patient

Thank you for agreeing to take time to complete this short survey. Feedback from this survey will help the surgery identify areas that may need improvement. Your opinions are very valuable. Please answer all the questions that apply to you. This questionnaire is anonymous and the practice will not be able to identify your individual responses.

Question 1

Information on our surgery – Which of the following do you use to gain information on Acle Medical Centre?

Practice Website

Surgery Newsletter

Practice Leaflet

Receptionist

Surgery Notice board

PPG Notice board

Any Other YES/NO - If yes please State

Question 2

Where applicable do you have any problems obtaining appointments with any of the following?

Doctors

Nurses

Phlebotomists

Physiotherapy

Chiropody

Counselling

Obtaining your Test Results

*If yes please explain

Question 3

Your Experience in the surgery building – Please indicate by circling how you rate the following

A) Public Areas – how do you find the area?:

B) Consulting Rooms – how do you find our rooms?:

C) Waiting Areas – was the level of comfort sufficient?:

D) Toilet Facilities – How do you rate our facilities here?:

E) Car Parking Facilities – How do you rate this?:

F) Disabled Facilities – How do you rate these?:

G) In the reception Area, do you feel that others could overhear what you were saying to the receptionist?

H) Are you aware that there is an area provided for anything confidential to be discussed?:

I) How easy did you find it getting into the building at the practice?

Question 4

Looking at the surgery as a patient, please indicate how you feel we accommodate your particular requirements in any of the following:

Teenager:

Young Families:

Hearing Impairment:

Visual Impairment:

Elderly:

Question 5

Are You?

Question 6

How old are you?

Question 7

Do you have any long-standing illness, disability or infirmity?

By long-standing we mean anything that has troubled you over a period of time or that is likely to affect you over a period of time :

Thank you for taking your time in completing this survey.