To help us analyse your answers please tell us a few things about yourself:

Are you male or female?

 
 

What age are you?

 
 
 
 
 
 
 
 

What is the ethnic background with which you most identify?

 
 
 
 
 
 
 
 
 
 

When did you join the practice? (Please include the month and year)

How often do you come to the practice?

 
 
 

How often have you seen a clinician in the last 3 months?

 
 
 

How would you describe your sexuality?

 
 
 
 

Do you have any disabilities?

 
 
 

We would also like to have your feedback about your experiences with any local services. this will help us to work with our local CCG in commisioning of future services for all patients in Kew and Richmond.

Please select a rating in response to the following:

The Practice opening hours:

 
 
 
 
 

Contacting the Surgery via the telephone:

 
 
 
 
 

Helpfulness of Practice Receptionists:

 
 
 
 
 

Availability of appointments with the doctor:

 
 
 
 
 

Availability of appointments with the nursing staff:

 
 
 
 
 

Ability to see the doctor of your choice:

 
 
 
 
 

The clinical care received from the doctor:

 
 
 
 
 

The approachability of the doctor:

 
 
 
 
 

The clinical care received from the nursing staff:

 
 
 
 
 

The approachability of the nursing staff:

 
 
 
 
 

The overall satisfaction with the practice:

 
 
 
 
 

Please comment on your rating if you wish:

Respect shown for your privacy and confidentiality:

 
 
 
 
 

Please comment on your rating if you wish:

Would you recommend the practice to someone who has recently moved to the area?

 
 

Please comment on your answer if you wish:

Please comment on two aspects of the practice that work well?

Please comment on two aspects of the practice that could be improved?