Are you Male or Female?
How old are you?
What do you consider your ethnicity to be (please state):-
Do you find the appointment system adequate for your needs?
If No, what would you like to change?
Other (please state):-
If you were unable to see/speak to a doctor, why was that?
What did you do as a result of being unable to see/speak to a doctor?
Wast this satisfactory?
Any further comments:-
How easy have you found getting through on the phone?
How easy have you found speaking to a doctor on the phone?
How easy have you found speaking to a nurse on the phone?
How easy have you found obtaining test results by phone?
The last time you visited the surgery did you see?
How good was the Health Care Professional at listening?
How good was the Health Care Professional at giving you enough time?
How good was the Health Care Professional at asking about your symptoms?
How good was the Health Care Professional at explaining tests and treatments?
How good was the Health Care Professional at involving you in decisions about your care?
How good was the Health Care Professional at treating you with care and consideration?
How good was the Health Care Professional at taking your problems seriously?
Do you feel that in the last 12 months the appointment system has improved?
Are you aware the practice has a website?
How often do you use the website, please state?
Are you aware prescriptions and appointments can be made online?
Do you have a mobile phone?
Do you have a email address?
Do you have a repeat prescription (if no move to Out of Hours Question)?
Was it ready on time?
Was it easy to order?
Did you know you can order your prescription via post?
Did you know you can order your prescription via Fax?
Did you know you can order your prescription online?
Did you know you can order your prescription in person via the prescription box?
Did you know you can order your prescription through the delivery driver if you are a dispensing patient?
Are you still taking all the medication on your prescription?
Do you know how to contact the Out of Hours Service/NHS 111 when the surgery is closed?
How easy was it to contact the Out of Hours/NHS 111 Service by telephone?
Did you have trust in the Out of Hours/NHS 111 doctor or clinician that you saw or spoke to?
Any further comments
Have you attended Accident & Emergency in the last 12 months?
If you answered yes to the above question and this was in surgery hours (8am-6pm) why did you attend Accident & Emergency and not the surgery?
Are you aware that the surgery offers Minor Illness/Minor Injury appointments?
How do you find the helpfulness of our Reception Staff?
How do you find the helpfulness of our Dispensary Staff?
How do you find the quality of information provided by Our Reception Staff?
How do you find the quality of information provided by our Dispensary Staff?
How do you find the confidentiality in the Waiting Room?
How do you find the comfort in the Waiting Room?
How do you find the amenities in the Waiting Room?
How do you find the patient information in the Waiting Room?
Are you aware the practice has a Patient Reference Group?
Do you have any recommendations to direct at the Patient Reference Group?
Would you recommend your GP Surgery to someone who has just moved to your local area?
Any further comments?