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* 1. Do you agree to take part in this survey sent to you by Unity Health? The data collected will be used to improve the service for Unity Health patients.

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* 2. What is your age group?

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* 3. What is your gender?

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* 4. Which of the following would best describe your marital status?

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* 5. Which of the following best describes your employment status?

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* 6. What is your usual surgery?

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* 7. Are you a carer? If yes, would you like to be contacted in regards to this?

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* 8. If you are a carer and would like to be contacted - Please enter your contact details here

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* 9. In general, how do you feel about making an appointment with the practice?

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* 10. How do you feel about our routine appointment availability? 

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* 11. If you have requested an urgent appointment before, how quickly has this request been responded to?

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* 12. If you do not use the telephone to contact the surgery, please specify your method of contatcing us.

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* 13. If you do use the telephone, how easy do you rate getting through to us?

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* 14. Do you feel like the phone lines have improved with the new phone system in place?

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* 15. How do you feel about the time keeping of the clinicians at the practice?

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* 16. How would you rate the overall service you have received in the past 12 months from the Doctors?

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* 17. How would you rate the overall service you have received in the past 12 months from the Nurses?

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* 18. How would you rate the overall service you have received in the past 12 months from the Pharmacists?

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* 19. How would you rate the overall service you have received in the past 12 months from the Receptionists?

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* 20. How would you rate the overall service you have received in the past 12 months from the Admin team (Medical reports and referrals) ?

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* 21. When you have been in the surgery at reception, have you ever had concerns about confidentiality? 

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* 22. Are you aware that we have a consulting room/window in our surgeries where you can speak to a receptionist with confidentially?

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* 23. How do you usually request your repeat prescription?

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* 24. Would you recommend the surgery to a friend or relative?

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* 25. Do you feel like the range of services offered by the surgery meet your health care requirements?

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* 26. Do you feel our website (www.unityhealth.info) is easy to navigate and has the relevant information for your needs?

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* 27. Do you live on or off the University Campus? 

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* 28. If you have ever taken a leave of absence, how would you rate the service?

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* 29. If you have ever needed a Confirmation of illness affecting assement form (COIAA) or a Letter to your department, how would you rate this service?

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* 30. If you have ever used the Open Door Services on campus, do you feel your needs are then being met at Unity Health also?

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* 31. Are there any other services that you would like to see at the surgery?

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