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Dear Patient,

Many thanks for agreeing to take this short survey to help our practice understand how our services can be improved, if at all.

Please answer all of the questions and click 'Send Survey' when you are done.

Q1. How do you rate the hours that the practice is open?

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Q2. If you have a disability how do you rate accessibility to the practice?

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Q3. How do you rate the way you are treated by the receptionists at the practice?

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Q4. How do you rate the ability to get through on the telephone?

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Q5. How do you rate the ability to pre-book an appointment with a Doctor (up to 2 weeks in advance)?

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Q6. How do you rate being able to see a Doctor on the day for an urgent problem?

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Q7. How do you rate the ability to speak to a Doctor on the telephone (telephone consultation)?

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Q8. How do you rate the medical treatment you received from the Doctor?

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Q9. How do you rate how quickly you can see a Nurse at the practice?

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Q10. How do you rate the medical treatment you received from the Nurse?

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Q11. How do you rate the treatment you have received from the practice Physiotherapist?

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Q12. How do you rate being able to order a repeat prescription (on the telephone, in person, on-line, etc)?

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Q13. How do you rate the facilities at the practice?

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Q14. How do you rate the appointments on our website?

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Q15. How do you rate the extended hours that are now available?

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Q16. How do you rate the practice newsletter?

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Q17. How do you rate the Out of Hours Service?

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Q18. If you had symptoms which caused you concern and lasted more than a month would you consider consulting the practice nurse or the GP?

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Q19. Would you recommend this Practice to anybody?

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Please answer the following questions if you have attended the Accident and Emergency department in the last three years:

Q1. What problem did you attend A&E with?

Q2. How long did you have the problem before attending A&E?

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Q3. Where were you when you became ill/had injury?

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Q4. Did you try to contact your own doctor's surgery?

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Q4a. If Yes to Q4, did the surgery advise you to attend A&E?

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Q4b. If No to Q4, was there a reason why you did not contact the surgery?

Q5. Why did you think going to A&E was your best option?

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Which practice are you most often seen at?

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What age are you?

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Your Ethnicity (Optional)?

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Do you feel that there are any services that you would like the practice to provide for patients in the future?

Do you have any other comments?

CASAG is The Castle Mead and Stoke Golding Action Group - a group of patients that meets monthly to discuss mutual issues concerning the practice. If you have any thoughts on what you would like CASAG to focus on, or discuss, please complete a comments sheet and place it in the suggestions box in the waiting room. They will be discussed at the next CASAG meeting. Keep up to date with the work of CASAG by reading the quarterly newsletter. In the past CASAG has run educational sessions for patients on relevant health topics. Is this something you would be interested in attending?

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If so what topics?

What day and time of the week would be best?

This survey is a national requirement for all practices. Thank you for taking the time to complete it. The results will be analysed in February 2013 and discussed with CASAG who will then publish a report of the results. This will be visible in the waiting room and also on this website.