patient satisfaction survey

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

Are you male or female?

Male

Female

What age are you?

Under 16

17 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 - 84

Over 84

What is the ethnic background with which you most identify?

White British

White Irish

Mixed White & Black Caribbean

Mixed White & Black African

Mixed White & Black Asian

Indian

Pakistani

Bangladeshi

Black Caribbean

Black African

Chinese

Other

How would you describe how often you come to the practice?

Regularly

Occasionally

Very Rarely

How would you describe your sexuality?

heterosexual

homosexual

bisexual

prefer not to answer

Do you have any disabilities?

yes please provide details :

prefer not to answer

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 tick in the box underneath your chosen rating:

1	The Practice opening hours:	Poor	Fair	Good	Very Good	Excellent


2	Contacting the surgery via the telephone:	Poor	Fair	Good	Very Good	Excellent


3	Helpfulness of the practice receptionists:	Poor	Fair	Good	Very Good	Excellent


4	Availability of appointments with the doctor:	Poor	Fair	Good	Very Good	Excellent


5	Availability of appointments with the nursing	Poor	Fair	Good	Very Good	Excellent
	staff:

6	Ability to see the doctor of your choice:	Poor	Fair	Good	Very Good	Excellent


7	The clinical care received from the doctor:	Poor	Fair	Good	Very Good	Excellent


8	The approachability of the doctor:	Poor	Fair	Good	Very Good	Excellent


9	The clinical care received from the nursing	Poor	Fair	Good	Very Good	Excellent
	staff:

10	The approachability of the nursing staff:	Poor	Fair	Good	Very Good	Excellent


11	The overall satisfaction with the practice:	Poor	Fair	Good	Very Good	Excellent

	Please comment on your rating if you wish:





12	Respect shown for your privacy and	Poor	Fair	Good	Very Good	Excellent
	confidentiality:

	Please comment on your rating if you wish:





13	Would you recommend the practice to	Yes	No
	someone who has recently moved to the area?
	Please comment on your answer if you wish:




14	Please comment on 2 aspects of the practice	1
	that work well:





15	Please comment on 2 aspects that could be improved

Kew Medical Practice

patient satisfaction survey