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Dear Patient,

Please take this annual opportunity to complete this survey and help shape our service to you. Please answer all of the questions and click 'Send Survey' when you are done.

1 Are you filling in this questionnaire for:

  92%
  4%
  1%
  1%
  2%

If you are filling this in for someone else, please answer the following questions from the patient’s point of view.

2 Which of the following best describes the reason you saw the doctor today? (Please tick all the boxes that apply)

  12%
  32%
  16%
  12%
  20%
  3%
  5%

3 On a scale of 1 to 5 (1 being not very important and 5 being very important), how important to your health and wellbeing was your reason for visiting the doctor today?

  5%
  5%
  21%
  19%
  44%
  6%

4 Which doctor did you see today?

  25%
  17%
  16%
  28%
  14%

5 How good was your doctor today at each of the following? (Please tick one box for each question)

a Being polite

  0%
  0%
  3%
  26%
  56%
  0%
  15%

b Making you feel at ease

  0%
  0%
  2%
  8%
  76%
  1%
  13%

c Listening to you

  0%
  0%
  4%
  10%
  72%
  0%
  14%

d Assessing your medical condition

  0%
  0%
  5%
  12%
  67%
  4%
  12%

e Explaining your condition and treatment

  0%
  0%
  4%
  11%
  64%
  8%
  13%

f Involving you in decisions about your treatment

  0%
  0%
  5%
  12%
  58%
  11%
  14%

g Providing or arranging treatment for you

  0%
  0%
  3%
  13%
  59%
  11%
  14%

6 Please decide how strongly you agree or disagree with the following statements by ticking one box for each question.

a This doctor will keep information about me confidential

  0%
  0%
  2%
  18%
  60%
  7%
  13%

b This doctor is honest and trustworthy

  1%
  0%
  1%
  16%
  63%
  4%
  15%

7 I am confident about this doctor’s ability to provide care

  84%
  0%
  16%

8 I would be completely happy to see this doctor again

  82%
  0%
  18%

9 Was this visit with your usual doctor?

  44%
  32%
  24%

10 How easy do you find getting into the building at the surgery?

  3%
  3%
  25%
  60%
  9%

11 How do you feel about how long after your appointment time you normally wait to be seen?

  59%
  26%
  5%
  10%

12 How helpful do you find the receptionists at the surgery?

  87%
  6%
  0%
  0%
  7%

13 Does the practice dispensary produce your repeat prescription within the 2 working days' target?

  64%
  7%
  1%
  28%

14 Would you attend the new North Cotswold Hospital in Moreton-in-Marsh for Out-patient appointments if more consultants held clinics at this location?

  80%
  5%
  8%
  7%

15 Are you:

  62%
  32%
  6%

16 Age:

  3%
  1%
  4%
  28%
  58%
  6%

17 What is your ethnic group? Please tick the appropriate box to indicate your cultural background.

  93%
  0%
  0%
  0%
  0%
  0%
  0%
  0%
  0%
  0%
  0%
  0%
  0%
  0%
  0%
  1%
  6%

Many thanks for your time in answering the questions on this survey.