35
GP Survey
Are you filling in this questionnaire for:
Which of the following best describes the reason you saw the doctor today? (Please tick all the boxes that apply)
On a sale of 1-5, how important to your health and wellbeing was your reason for visiting the doctor today?
How good was your doctor today at being polite?
How good was your doctor today at making you feel at ease?
How good was your doctor today at listening to you?
How good was your doctor today at assessing your medical condition
How good was your doctor today at explaining your condition and treatment?
How good was your doctor today at involving you in decisions about your treatment?
How good was your doctor today at providing or arranging treatment for you?
Please decide how strongly you agree or disagree with the following statement: This doctor will keep information about me confidential
Please decide how strongly you agree or disagree with the following statement: This doctor is honest and trustworthy
I am confident about this doctor's ability to provide care
I would be completely happy to see this doctor again
Was this visit with your usual doctor?
Please add any other comments you want to make about this doctor. Please note: No patients will be identified when this information is given to the doctor
Please provide details about the patient.
Are you
Age
What is your ethnic group?