Upper Gordon Road Surgery

Friends and Family Survey Oct 2016

We would be grateful if you would complete this short survey about your recent experience of our service.There are no right or wrong answers and we will NOT be able to identify your individual answers. Thank you.

Q1 How likely are you to recommend our GP Practice to friends and family if they needed similar care or treatment?

Yes, Extremely Likely

Yes, Likely

No, neither likely or unlikely

No, Extremely unlikely

Don’t know

It will help us to understand your answers if you could tell us a little about yourself

Q2 Are you ?

Male

Female

Q3 How old are you?

Under 15

16 to 24

25 to 34

35 to 44

45 to54

55 to 64

65 to 74

75 to 84

85+

Q4 What is your ethnic group?

White

Black or Black British

Asian or Asian British

Mixed

Chinese

Other ethnic group

Q5 Are you?

The patient

the parent or carer

the patient and parent/carer

If you do not wish your anonymous comments to be shared the please tick here:

No

Finally, please add any other comments you would like to make about your GP practice:

GPAQ-R © 2013 is reproduced with the kind permission of the University of Manchester & University of Cambridge. GPAQ incorporates the Primary Care Assessment Survey (PCAS); with permission from Dr Dana Gelb Safran