All personal data acquired by North West Surrey Clinical Commissioning Group and partners shall only be used for the purposes of this procurement and shall not be further processed or disclosed without the consent of the applicant. Please do not include any personal information, such as your name or contact details, either for yourself or someone else.

* 1. Have you previously used the NHS 111 service for yourself or someone you care for?

* 2. If not, why not?

* 3. If yes, please rate your experience?

* 4. If your experience was poor please select a reason from the answers below and tell us more.

* 5. What are the most important existing NHS 111 services? Please tick your top FOUR.

* 6. Have you, or someone you care for, previously been seen by the GP Out of Hours service?

* 7. Please tell us about your experience of the GP Out-of-Hours service?

* 8. Currently, GP Out of Hours facilities are located in the following areas. Which, if any of these, is the most convenient location to you?

* 9. If you could influence future changes to how you access care from NHS 111, which two suggestions would be most important to you.

* 10. Do the suggestions above increase the likelihood of you using the NHS 111 service?

* 11. What is the nearest town to you?

* 12. Are you male or female?

* 13. What is your age?

* 14. Are you a carer?

T