CSurvey (for patients age 16+)

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Are you filling in this survey for:
Yourself
Your child
Someone I care for who has accessed a service the Practice offers
Which of the following best describes the reason you contacted us today?
To ask for advice
Because of a one-off problem
Because of an ongoing problem
For a routine check
For treatment (including prescriptions and sick notes)
Other (please provide details)

On a scale of 1 to 5, how important to your health and wellbeing was your reason for contacting us today?
Not very important
Somewhat important
Important
Very important
Urgent
How good was the Practice staff who assisted you today at each of the following?
Being polite:
Poor
Satisfactory
Good
Very Good
Does Not Apply
Making you feel at ease:
Poor
Satisfactory
Good
Very Good
Does Not Apply
Listening to you:
Poor
Satisfactory
Good
Very Good
Does Not Apply
Providing explanation:
Poor
Satisfactory
Good
Very Good
Does Not Apply
(Optional) Please decide how strongly you agree or disagree with the following statements:
The Practice staff will keep information confidential:
Disagree
Agree
Does Not Apply
The Practice staff is trustworthy:
Disagree
Agree
Does Not Apply
Which of the following best describes you?
Female
Male
I prefer to self-identify (optional)
Prefer not to answer
Age:
Under 16
16-20
21-40
41-60
60 or over
In which borough do you reside?
Westminster
Royal Borough of Kensington and Chelsea, Hammersmith and Fulham
Brent, Ealing, Harrow, Hillington, Hounslow
Other London boroughs
I reside outside of London
Prefer not to answer

5 + 6 =