1. Please tick the age group of the patient
2. Where does the patient live?
3. When the Doctor telephoned you, were you given advice over the phone?
If you answer Yes, please answer question 4 then add any other comments and finish: If you answer No, please go to question 5 and continue
4. How satisfied were you with the advice given?
5. Did you get an appointment on the day of your choice?
6. Were you seen at at time convenient to you?
7. If you specified a GP, were you able to see that GP?
8. How did you travel to your appointment?
9. Any other comments