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* 1. Which Medical Centre do you attend

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* 2. Please identify your age range

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* 3. Have you ever put off going to see your doctor because of difficulty getting to the surgery

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* 4. How do you usually get to the surgery

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* 5. How polite and courteous do you find the Reception Team? (1 being poor and 5 being excellent)

  1 2 3 4 5
On the phone
At the Reception Desk

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* 6. In the past 6 months, how easy have you found the following?

  Very easy Quite easy Quite difficult Very difficult Don't know/never tried
Getting through on the phone
Speaking to a Doctor or Nurse on the phone
Obtaining test results by phone
Booking an appointment 

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* 7. The last time you saw a Doctor at the surgery do you feel you had enough time to discuss your concerns? ( 1-5 below, 1 being not nearly enough time and 5 being more than enough time)

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* 8. Thinking about the last time you saw a doctor or nurse at your surgery, did you feel confident about how they helped you? 

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* 9. In general how satisfied are you with the care you receive at the surgery?
(1 being unsatisfied and 5 being completely satisifed)

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* 10. Would you prefer the written information in the surgery to be provided in another language?

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* 11. Are you aware that there is a Patient Participation Group:

  Yes No
Which represents the views of patients?
Available through the practice website?

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* 12. Would you recommend this Medical Practice to friends or family?

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* 13. What is the Practice doing well for you and what could be improved? Please type below: 

T