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SAPA5 Patient Participation Group
1.
How often have you had contact with your G.P practice during the past 12 months?
0
1 - 5
6 - 10
more than 10
2.
Were you aware that your G.P practice is a part of SAPA5 Primary Care Network?
Yes
No
3.
Tick all of the services below that you have been involved with during the past 12 months?
Link Support Worker
Care Coordinator
Welfare Coach
Stop Smoking
Physiotherapist
None of the above
4.
Were you aware that your G.P practice could offer the services that have been mentioned in question 3 above?
Yes
No
5.
How young are you?
18 – 25
26 – 40
41 – 55
56+
6.
Can you support SAPA5 Network Patient Participation Group for a couple of hours a month?
Yes
No
7.
If you can help, how would you like to attend the meetings?
Face to Face
On Line
8.
How could we contact you? Please provide telephone number, email address or postal address.
9.
What is your first name?
10.
Thank you for taking the time to complete this questionnaire, your support is appreciated. If you would like to add in anything please do so below.