Friends and Family Test

Highcliffe Medical Centre

Thank you for taking the time to complete this Friends and Family Test regarding your experience as a patient at Highcliffe Medical Centre. We welcome your honest feedback, information from which will be collated at the end of each month and the results published on our website, www.highcliffemedicalcentre.co.uk.

Any comments you make will be included in their entirety but all attempts will be made to remove information that could make you identifiable. If you tick the last box of this questionnaire stating you do not wish for your comments to be made public then they will be shared anonymously with centre staff and members of our Patient Participation Group only.

Question Title

* 1. We would like you to think about your recent experiences of our service. How likely are you to recommend our GP practice to friends and family if they needed similar care or treatment?

Extremely likely

Likely

Neither likely nor unlikely

Unlikely

Extremely unlikely

Don't know

Question Title

* 2. Please explain why you answered as you did in question1.

Question Title

* 3. Please select your gender.

Male

Female

Question Title

* 4. Please select your age.

0-15

16-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

Question Title

* 5. Please select your ethnic group.

White

Mixed/Multiple ethnic groups

Asian/Asian British

Black/African/Caribbean/Black British

Other ethnic group

Question Title

* 6. Are your day-to-day activities limited due to a health problem or disability which has lasted, or is expected to last, at least 12 months (including issues related to old age)?

Yes, limited a lot

Yes, limited a little

Prefer not to say

Question Title

* 7. Please select the box below if you DO NOT wish for your comments in question 2 to be made public.

I do not wish for my comments to be made public.