We are keen to hear your views on the evening and weekend GP service you have just used. We are doing this to make sure that health services being offered locally, meets everyone’s needs. Thank you in advance, for your support.

* 1. Which GP surgery are you registered with?

* 2. Where did you attend your evening/weekend appointment?

* 3. Did you have an evening or weekend appointment?

* 4. Was the appointment for you or someone else you care for?

* 5. Who did you see for your appointment?

* 6. Were you seen on the same day that you booked your appointment?

* 7. Do you think waiting times to book an appointment have reduced?

* 8. Have you been able to access a GP appointment more easily due to the evening/weekend opening?

* 9. If an evening or weekend appointment could not have been offered on this occasion, what would you have done instead?

* 10. How old are you?

* 11. Please tell us your gender

* 12. What is your ethnic origin:

* 13. Any further comments