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Patient Survey for Dr Biggs General Medical Council 2017
1: Are you filling in this questionnaire for:
If you are filling this in for someone else, please answer the following questions from the patient's point of view
2: Which of the following best describes the reason you saw the doctor today? (Please tick all the boxes that apply)
3: On a scale of 1 to 5, how important to your health and wellbeing was your reason for visiting the doctor?
4: How good was your doctor today at each of the following?
4a: Being polite
4b: Making you feel at ease
4c: Listening to you
4d: Assessing your medical condition
4e: Explaining your condition and treatment
4f: Involving you in decisions about your treatment
4g: Providing or arranging treatment for you
Working with doctors Working for patients
5: Please decide how strongly you agree or disagree with the following statements by ticking one box in each question
5a: This doctor will keep information about me confidential
5b: This doctor is honest and trustworthy
6: I am confident about this doctor's ability to provide care
7: I would be completely happy to see this doctor again
8: Was this visit with your usual doctor?
9: 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
The next questions will provide the doctor with some basic information about who took part in the survey. If you are filling this in on behalf of a child or a patient with a disbility, please provide details about the patient.
10: Are you:
11: Age:
12: What is your ethnic group?
A:White
Please write in
B: Mixed
Please write in
C: Asian or Asian British
Please write in
D: Black or Black British
Please write in
E: Chinese or other ethnic group
Please write in
ANY OTHER COMMENTS