1. What is your age?
2. What is your Gender?
3. Do you have a long-term health condition?
4. Were you having frequent and regular consultations with a Health Professional?
5. If the answer to the previous question is ‘yes’ and your visits have stopped because of the change in procedures, has this affected your physical/mental health?
6. If you have requested to speak to a particular Health Professional have you been able to?
7. Are you able to explain your condition using a telephone?
8. Do you have any concerns about speaking to a Health Professional when using a telephone?
9. Do you consider you would be able to see a Doctor face to face if you thought it essential?
10. If you have had reason to visit the Practice for a face to face consultation, did you feel safe, cared for and protected whilst you were there?
11. If you are on regular medication are you able to obtain medicines when required and without difficulty?
12. Would you be prepared to participate in a video consultation?
13. If you have any further comments please enter them here.