Patient Questionnaire - February 2012
This questionnaire has been developed in conjunction with our new Patient Reference Group (PRG) to provide further feedback on topics identified by patients in previous surveys as areas of interest, as well as some new ideas for the future. The questionnaire is confidential. The results will be analysed and a full report published on our website in March 2012.
Please answer the following questions by selecting the answers most appropriate to you. For some questions you may want to tick more than one answer. Add your comments where space is provided.
1. Are you a registered patient at Priory Surgery?
2. Who is your usual doctor?
3. Do you know the current surgery opening times?
3a. If yes, where did you find out about opening times? (you may tick more than one answer)
Other (please specify):
3b. If no, where would you expect to be able to find the information? (you may tick more than one answer)
Other (please specify):
4. Are you aware that we offer Extended Hours surgeries on one evening every week?
4a. If no, please tell us where you would expect to be able to find details of this service?
Other (please specify):
4b. Have you booked Extended Hours appointments in the past?
4c. Would you book Extended Hours appointments in the future?
4d. What times do you think would suit most patients?
Other (please specify):
5. Overall, are you happy with the appointment availability at Priory Surgery?
5a. If no, please given your reasons:
6. Overall are you happy with our current system for booking appointments?
6a. Have you experienced difficulty when making an appointment on the phone?
6b. Have you experienced difficulty when making an appointment in person?
6c. Do you think an automated telephone booking service would be useful?
6d. Do you think an online booking service would be useful?
6e. Which method of booking would you be most likely to use in the future? (you may tick more than one answer)
Other (please specify):
6f. Any other comments about the appointment system?
7. Have you ever forgotten to attend an appointment?
8. Would you like to be reminded about your appointment?
8a. How would you like to be reminded?
Other (please specify):
9. Do you use our repeat prescription service?
9a. Which methods have you used to order your prescriptions in the past?
Other (please specify):
9b. Are you aware that there are pharmacy collection/delivery services?
9c. Are you likely to use these services in the future?
10. Did you know that Priory Surgery had a website?
10a. Have you visited the website in the past?
10b. If yes, did you find the information you were looking for?
10c. If no, what information were you trying to find?
10d. What information do you think we should include on our website?
11. Do you have a computer or access to email?
11a. Would you like to be consulted regularly about our services by joining the new Patient Reference Group? If yes, please complete the separate sign-up form available at reception
12. Do you look at the noticeboards in the surgery?
Any comments about our noticeboards or ideas for information to be displayed? (eg specific health topics, general information, themed notice boards etc)
13. Do you have any ideas for articles to feature in future Practice newsletters?
If yes please give details:
14. Any other comments or suggestions?
The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice and to see how experiences vary between different groups of the practice population.
Your Gender:
Your Age:
The ethnic background with which you most closely identify is:
White:
Mixed:
Asian or Asian British:
Chinese or Other:
How often do you come to the practice?
Are you a Carer for anyone with a;longstanding health problem or disability?
Do you have a Carer?
Do you have any of the following conditions ? (please include problems due to old age)
Thank you for helping with our survey