Dear Patient,

We are undertaking a patient survey to ensure that we are maintaining a high quality of care and to highlight any areas that could be improved.
Please answer all of the questions and click 'Send Survey' when you are done.

Firstly please select what you have had done at the surgery and are giving us feedback about:

 
 
 
 
 
 
 

Who was your appointment with?

 
 

Please tick the relevant number on the rating table for the following questions.
0=Not Applicable 1= POOR & 6= EXCELLENT

Q1. Was your telephone query dealt with efficiently?

 
 
 
 
 
 
 

Q2. Were you given an appointment time that suited you?

 
 
 
 
 
 
 

Q3. Were you given clear instructions (If needed) to the surgery?

 
 
 
 
 
 
 

Q4. Was there easy access to the premisses?

 
 
 
 
 
 
 

Q5. Please rate our waiting room (E.g Comfort, Information, Decoration)?

 
 
 
 
 
 
 

Q6. Was your appointment on time?

 
 
 
 
 
 
 

Q7. Were you given an explanation of your diagnosis and treatments?

 
 
 
 
 
 
 

Q8. Did you feel you were treated with care and compassion?

 
 
 
 
 
 
 

Q9. Did you feel involved in the decisions made about your treatment?

 
 
 
 
 
 
 

Q10. Were you given information about any medication perscribed?

 
 
 
 
 
 
 

Q11. Do you feel your treatment was effective?

 
 
 
 
 
 
 

Q12. Were you satisfied with the overall treatment?

 
 
 
 
 
 
 

Q13. We would like you to think about your recent experience of our service. How likely are you to recommend our service to friends and family if they needed simular care or treatment?

 
 
 
 
 

If you would like to qualify any answers or add any other comments please do so in the space below:


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

Are you male or female?

 
 

What age are you?

 
 
 
 
 
 
 
 
 

What is the ethnic background with which you most identify?

 
 
 
 
 
 
 
 
 
 
 
 

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

 
 
 

Many thanks for your time in answering the questions on this survey.