Frome Valley Medical Centre
Friends & Family Test
How likely are you to recommend our GP Surgery to friends and family if they needed similar care or treatment?
Extremely likely
Likely
Neither likely nor unlikely
Unlikely
Extremely unlikely
Don’t know
If we could change one thing about your care or treatment to improve your experience, what would it be?
Did you attend today as a?
Patient
Parent or Guardian of a Patient
Carer of a Patient
Please answer the following questions
Your gender?
Male
Female
Your age?
0-15
16-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Ethnic Group?
White
Mixed/Multiple Ethnic groups
Asian/Asian British
Black/African/Caribbean/Black British
Other Ethnic group
Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months? (Include any issues/problems related to old age)
Yes limited a lot
Yes limited a little
No
Prefer not to say
Do you wish your comments to be published
Yes
No
Thank you for completing this questionnaire