Henfield Medical Centre

Be Heard in Henfield

A Questionnaire for Young People

What is your age?

14-16

19-21

22-24

Are you at;

School

College

University

Work

Other

Where?

Who do you normally come to the surgery with?

On my own

With my parents

With a friend

With my partner

Other

Do you feel you can seek advice easily?

Yes

No

If no, Why?

Is it easy to book an appointment?

Yes

No

If no, Why?

Don't like calling the surgery

Don't like coming with my parents

awkward times available

Don't like telling the receptionist the problem.

Is there a time of day easier for you to see a Doctor or Nurse and what time?

Would you use an App to help you with your appointment before coming?

eg DocReady

Yes

No

Would a chat with a Doctor or Nurse be easier by

Skype

Facebook

Facetime

Twitter

Telephone appointment

Text

In a Group

Happy with usual face to face appointment

Did you know you can attend with a friend?

Yes

No

Do you feel awkward coming to see the Doctor or Nurse with any problem?

Yes

No

If yes, Why?

Worried you will tell my parents/teacher/friends

Forgetting the questions

Feel embarrassed

Would rather see a male GP

Would rather see a female GP

Worried about other people seeing me in there

Not sure the problem is important

Difficulty getting appointment

Do any of these reasons stop you from coming?

Do you know where to go for the following (select the box if the answer is YES)

Addiction advice

Drug advice

Alcohol advice

Gambling advice

mental health advice

Weight problems

If you need sexual health advice who would you ask?

Nurse

Gp

Clinic

Parents

Friend

Other

Are you aware we offer free Condoms, Chlamydia tests and Contraception?

Yes

No

Would you use our website to get information if we had a young person's section?

Yes

No

If you wish to be entered in the prize draw to win a £10 voucher

Please enter your Name/Mobile number below?

THANK YOU