FFT FEEDBACK FORM - DR SHANTIR'S PRACTICE

We would like to you to think about your recent experience of the service.

Everyone working for the NHS has a legal duty to keep information about you confidential.

Please complete all questions, all the information you supply us with will be used lawfully, in accordance with the Data Protection Act 1998. The Data Protection Act 1998 gives you the right to know what information is held about you and sets out the rules to make sure that this information is handled properly.

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* 1. How likely are you to recommend our service to friends and family if they needed simmilar care or treatment?

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* 2. What is the main reason for your answer to question 1?

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* 3. Are you?

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* 4. How old are you?

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* 5. Do you consider yourself to have a disability?

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* 6. Which of the following describes your ethnic background?

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* 7. Who was the main person who answered the questions?

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* 8. Do you wish the anonymous comments to be shared?

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