THREE SHIRES G.P. PRACTICE PATIENT SURVEY 2018

Three Shires GP practices have formed a new Patient Participation Group (PPG) Our aims are to advise and influence the Practice from a patient perspective, put forward ideas and suggestions from patients to develop the Practice and improve communication between the Practice and patients. PPGs often organise health events, signpost patients to support and help set up services such as support groups, befriending and volunteer transport. Please could you help us to do this by filling in this form. If you are filling it in for another patient please complete it from their point of view.

How often do you use your Practice's services?

 
 
 
 
 
 
 

Do you use the Practice Website / Patient Access to book appointments or order repeat prescriptions?

 
 
 

If you (or your child or someone you care for) has a long-term condition, would you like to attend a group or belong to an on-line forum for mutual support? If so, which condition?

 
 
 
 
 
 

 
 
 

Do you look after someone else, who couldn’t manage without your help?

 
 

If yes, please give your contact details at the end of this questionnaire so that we can contact you with information and support.

Would you be interested in a befriending (telephone or visit) or Good Neighbour / LINK scheme? (i.e. someone to telephone or visit you?)

(If yes, please give your contact details at the end of this questionnaire)

 
 

Would you be interested in volunteering for such a scheme?

(If yes, please give your contact details at the end of this questionnaire)

 
 

Would you be interested in being a member of an email (i.e. virtual) group that could contact you from time to time to ask for your views on particular issues?

(If yes, please give your contact details at the end of this questionnaire)

 
 

Would you find a volunteer hospital transport scheme helpful?

 
 

Any other comments or suggestions that you would like passed on to the medical team and managers?

Which surgery are you registered with?

 
 
 
 

Demographics

Are you

 
 
 
 

Age

 
 
 
 
 

Ethnicity

White

 
 
 

Mixed

 
 
 
 

Asian or Asian British

 
 
 
 

Black or Black British

 
 
 

Other Ethnic Groups

 
 
 

(Optional) Name, Email, Phone Number

if you are happy to be contacted

Please click the Button Below to send your responses. Many thanks