Your Gender?
Your Age Range
How long have you been a patient at this surgery?
How many times have you visited this surgery in the past 12 months for medical care?
Are you aware of the full service your GP provides?
Which of the following describes the reason you saw your Doctor / Nurse today?
How satisfied are you with the following? - Our practice appearance
How satisfied are you with the following? - Telephone systems in the practice
How satisfied are you with the following? - The helpfulness of our reception staff
How satisfied are you with the following? - The knowledge and communication skills of our reception staff
How satisfied are you with the following? - Did you get your preferred appointment
How satisfied are you with the following? - Waiting time in our surgery
How satisfied are you with the following? - The time it takes reception staff to answer your telephone call when you call to book an appointment or have a query
How satisfied are you with the following? - Ease of making appointments at the surgery (checkups,emergency,injections,routine follow-ups,etc)
How satisfied are you with the following? - Ease in speaking direct with your doctor by telephone
How satisfied are you with the following? - Re-assured you can obtain follow-up information and care (test results, referrals, medication)
How satisfied are you with the following? - The Doctor/Nurse made you feel at ease and listened (not cold or abrupt, let you describe your illness or needs in your own words)
How satisfied are you with the following? - The Doctor/Nurse explained things clearly (fully answering your questions and giving you adequate information)
How satisfied are you with the following? - The Doctor/Nurse assessed your medical condition correctly
How satisfied are you with the following? - The Doctor/Nurse explained your condition and treatment so you clearly understood
How satisfied are you with the following? - You are confident that the Doctor or Nurse will keep information about you confidential
How satisfied are you with the following? - You are confident with the Doctor or Nurses ability to provide care
How satisfied are you with the following? - Overall you were happy with the surgery today
Was your appointment booked with your usual Doctor or Nurse?
Would you be happy to see this Doctor/Nurse again today?
Will you recommend this surgery to your friends and family?
Please add any other comment you want us to be made aware of, you will not be identified in any way