Alum Rock Medical Centre

Patient experience and satisfaction survey

How would you rate the surgery reception?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate the surgery waiting area?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate the surgery consultation rooms?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate the cleanliness of the surgery reception?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate the cleanliness of the surgery waiting area?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate the cleanliness of the surgery consultation rooms?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How easy is it to get through to the reception on the telephone?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How easy is it to get an appointment in advance with the doctors?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How easy is it to get an appointment in advance with the nurse?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How easy is it to get an appointment in advance with the Healthcare assistant (HCA)?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How easy is it to see the doctor within 24hours?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How easy is it to see the nurse within 24hours?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How easy is it to see the HCA within 24hours?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate the waiting time to see the doctor once you have arrived at the surgery?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate the waiting time to see the nurse once you have arrived at the surgery?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate the waiting time to see the HCA once you have arrived at the surgery?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate your experience at the surgery with the doctor?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate your experience at the surgery with the nurse?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate your experience at the surgery with the HCA?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate our current opening hours?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate our current opening hours?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

How would you rate the communication of test results via telephone?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

Are you aware that the surgery has both a practice leaflet and website?

Neither 

Both 

Website only 

Leaflet only 

Are you aware that you are able to access your medical records?

Yes 

No 

If Yes, do you know the process for requesting access to your medical records?

Yes 

No 

Are you aware that we have a full-time female GP?

Yes 

No 

During your surgery consultation, (if you were being referred to the hospital) did the doctor explain the referral process clearly?

Yes 

No 

During your surgery consultation, (if you were being referred to the hospital) were you given choices regarding your treatment and location?

Yes 

No 

How satisfied are you overall with the surgery?

Excellent 

Good 

Average 

Poor 

Very Poor 

Not Used 

Are there any comments you would like to make regarding the surgery?

Are you male/female?

Male 

Female 

What age group are you in?

Under 16 

17-24 

25-34 

35-44 

45-54 

55-64 

65-74 

75-84 

Over 84 

What is your ethnic background?

White British 

White Irish 

Mixed White and Black Caribbean 

Mixed White and Black African 

Mixed White and Asian 

Asian or Asian British - Indian 

Asian or Asian British Pakistani 

Asian or Asian British Bangladeshi 

Black or Black British Caribbean 

Black or Black British African 

Chinese 

Any other Ethnic group