Patient Questionnaire
Please complete all questions if possible
What is your age?
18-24
25-34
35-44
45-54
55-64
65 or older
Prefer not to say
What is your gender
Male
Female
Non-binary
Prefer not to say
Do you consider yourself to have a disability or any additional needs?
Yes
No
How did you access the practice today?
By Telephone
In Person at Reception
Using the Practice Website
Using the NHS app
On a scale of 1 to 5, where 1 is very difficult and 5 is very easy, how easy was it to schedule your appointment?
1
2
3
4
5
1 is , 5 is
What is your preferred method of contact by the practice for consultations?
By Telephone
In Person
An online consultation
A text message
On a scale of 1 to 5, where 1 is very poor and 5 is excellent, how would you rate the knowledge and expertise of the healthcare professionals who provided your care?
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Did you consider contacting 111, the Pharmacy or any other health or social care provider prior to the GP practice to request an appointment?
Yes
No
Not appropriate
Didn't know I could
Additional Comments to Previous Question
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On a scale of 1 to 5, where 1 is very poor and 5 is excellent, how would you rate the availability of information about your condition and treatment?
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
What member of the healthcare team did you see?
GP
Advanced Nurse Practitioner
Nurse or Healthcare Assistant
Phlebotomist
Mental Health Nurse/Enhanced Recovery Worker
Physiotherapist
I don't know
Overall, how was your experience of our service?
Very Good
Good
Neither good nor poor
Poor
Very Poor
Don't Know
Do you have any additional comments or feedback about your experience with your practice?
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