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* 1. Which Medical Centre are you currently registered with?

* 2. How often do you use the Medical Centre?

* 3. What is your most common reason for visiting the Medical Centre?

* 4. How far do you travel from your home to the Medical Centre?

* 5. How do you normally travel to the Medical Centre?

* 6. Which of the following extra services do you think you would take advantage of?

* 7. Please tell us how you feel merging the two practices would affect you and if there is anything you think we could do to make things easier for you.

* 8. Both sites offer extended access by running clinics at the following times ,Thursday Morning 06.30 -08.00 Saturday Morning 08.30 -11.00 Do these appointments suit your needs?

* 9. If the practices did merge you would automatically be registered with the new merged practice, or you could choose to register with a different GP practice. Would you continue to use this practice or move to an alternative practice?

* 10. If you would move to another practice, please tell us why:

* 11. Do you have any other comments that you would like to make?

* 12. In order to ensure that we provide the best services for all of our communities, and to ensure that we do not knowingly discriminate against any section of our community, it is important for us to gather the following information. No personal information will be released when reporting statistical data and all information will be protected and stored securely in line with data protection rules. This information will be kept confidential and you do not have to answer all of these questions, but we would be very grateful if you would.Please tell us the first part of your postcode (e.g. S9, S35)

* 13. What is your gender?

* 14. Transgender Is your gender identity different to the sex you were assumed to be at birth?

* 15. What age group are you in?

* 16. What is your sexual orientation?

* 17. What is your ethnic background?

* 18. Do you consider yourself to belong to any religion?

* 19. Do you consider yourself to be disabled? The Equality Act 2010 states that a person has a disability if: ‘a person has a physical or mental impairment, and the impairment has a substantial and long-term adverse effect on that their ability to carry out normal day-to-day activities’

* 20. If you have a disability, what type of disability do you have?

* 21. Do you provide care for someone? Such as family, friends, neighbours or others who are ill, disabled or who need support because they are older.

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