To help us better analyse the responses from this survey please could you tell us the basis on which you are sharing your views.

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* 1. To help us better analyse the responses from this survey please could you tell us the basis on which you are sharing your views.

Which surgery do you normally visit?

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* 2. Which surgery do you normally visit?

How do you normally travel to appointments at this surgery?

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* 3. How do you normally travel to appointments at this surgery?

We would like to ask you how you feel the proposal for the change will impact on you…
How do you think the closure of Wollaston branch surgery will affect you?

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* 4. How do you think the closure of Wollaston branch surgery will affect you?

How do you think it will affect other patients registered at Three Villages Medical Practice?

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* 5. How do you think it will affect other patients registered at Three Villages Medical Practice?

If you think the proposal will have either a negative impact or a positive impact – please can you tell us what the impacts are and who you think it will affect?

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* 6. If you think the proposal will have either a negative impact or a positive impact – please can you tell us what the impacts are and who you think it will affect?

What do you think we can do to lessen any negative impacts?

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* 7. What do you think we can do to lessen any negative impacts?

What else can we consider along with this proposal?

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* 8. What else can we consider along with this proposal?

Is there anything else you would like to tell us?

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* 9. Is there anything else you would like to tell us?

We would appreciate if you can tell us a little bit about yourself.
We are asking these questions to better understand and analyse the responses from the survey questions.
What is your gender?

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* 10. What is your gender?

Which of the following age categories do you fit into?

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* 11. Which of the following age categories do you fit into?

Choose one option that best describes your ethnic group or background

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* 12. Choose one option that best describes your ethnic group or background

What is your religion?

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* 13. What is your religion?

Please tell us the first part of your postcode and the first character of the second part of your postcode where you live (e.g. DY* 3**) by ticking the corresponding box below. 
Please note this is not personally identifiable to your address but helps us to understand where the responses are coming from in our analysis.

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* 14. Please tell us the first part of your postcode and the first character of the second part of your postcode where you live (e.g. DY* 3**) by ticking the corresponding box below. 
Please note this is not personally identifiable to your address but helps us to understand where the responses are coming from in our analysis.

Thank you for taking the time to complete this survey.

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