How were you feeling on your last visit to the practice?(0 = Not at all 1 = A tiny bit 2 = Mostly 3 = Definitely)
How would you describe the surgery surroundings?(please tick all you feel appropriate)
Thinking about the environment health staff work in, please tick one box for each. Do you feel this environment has a POSITIVE impact on:
Their overall communication skills
Their overall listening skills
Their ability to get you to open up
Their ability to gain your trust
Their ability to create a rapport
Do you think that the way your current surroundings look could be improved?
If you answered "yes" or "maybe", what would you like to see?
About you (please tick)
Age