General Practice Doctors Questionnaire

Today's date:

Doctor visited:

1. Which of the following best describes the reason why you came in? (Please tick all the boxes that apply)


If other, please give details.

2. Thinking about booking your appointment and the related administration, please let us know how you found the experience:

i) where did you hear about our practice?

ii) The information available on our practice (e.g. website)


iii) The ease of booking an appointment


iv) The charging structure was explained clearly


v) The practice info, confirmation and T&Cs are clear


vi) Our welcome / greeting on your arrival


vii) The punctuality of your appointment time


viii) Your impression of the practice environment


ix) What do you consider the overall cleanliness?


x) You had easy physical access to the practice


3. How good was your doctor at each of the following?

i) Making you feel at ease


ii) Letting you tell your story & listening to you


iii) Assessing your medical condition


iv) Explaining your condition and treatment


iv) Involving you in decisions about your treatment


vi) Giving you the chance to ask questions & raise concerns


vii) Providing or arranging treatment for you


viii) Clearly explaining what you will be charged


4. How strongly do you believe that your information will be kept confidential?


5.How strongly do you believe that the doctor is honest and trustworthy?


6. I am confident about this doctor's ability to provide care


7. I would be happy to see this doctor again


8. You were provided with clear verbal & written instructions


9. I was shown respect for my religious and cultural beliefs


10. Was this visit with your usual doctor?


11. Would you recommend the practice to others?


Please add any other comments you want to make about this doctor.

Please add any other comments you wish to make about the practice.