Please tell us the name of your Doctor? Dr. Basma Dr. Wright Dr. Dass Dr. Macbeth

In the past 12 months how many times have you seen a Doctor from this practice? 1-2 3-4 5-7 8-10 more than 10

How do you rate the service provided by the Receptionists at the Practice? Excellent Good Average Poor

Are you generally satisfied with the Surgery opening hours? Yes More or Less No

Thinking of times when you want to see a particular doctor, how easy is it to do so? Very Easy Usually OK Quite Difficult

If you need to see a GP urgently, can you normally get to see one on the same day? Yes Usually No

How long do you usually have to wait at the Practice for your appointment to begin? Less than 1 minute 2 - 5 minutes 5 - 10 minutes 15 - 30 minutes 30 minutes plus

Thinking of times when you have telephoned the Practice, how long have you had to wait for a response? Less than 30 seconds Between 30 seconds & 2 minutes Longer than 2 minutes

How thorough is the Doctor in asking about your symptoms & how you are feeling? Excellent Good Average Poor

How well do you feel that the Doctor put you at ease? Excellent Good Average Poor

How well does the Doctor explain your problems and eventual diagnosis? Excellent Good Average Poor

How thorough is the Nurse in asking about your symptoms & how you are feeling? Excellent Good Average Poor

How well do you feel that the Nurse put you at ease? Excellent Good Average Poor

How well does the Nurse explain your problems and eventual diagnosis? Excellent Good Average Poor

Are you Male or Female? Male Female

How old are you? Under 20 20-30 31-40 41-50 51-60 61-70 71-80 81-90 Over 90

Do you have a condition which requires you to attend a Doctor / Nurse appointment on a regular basis? Yes No

Which of the following best describes you? Retired Professional Student Teacher Manufacturing

We are interested in any other comments you might have which you feel you wish to share with us. Please be brief:-