Friends and Family Test

Printable Version

How Likely are you to recommend our practice to friends and family if they needed similar care or treatment? *

Extremely Likely

Likely

Neither Likely or Unlikely

Extremely Unlikely

Don't Know

Thinking about your response to this question, what is the main reason why you feel this way? *

A little bit about you:

Are you? *

Male

Female

Other

What age are you? *

0-15

16-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

Do you consider yourself to have a disability? *

Yes

If yes, could you give some details?

Which of the following best describes your ethnic background? *

Are you? *

Thank you for completing the form and providing us with feedback to improve our services. If you DO NOT wish your anonymous comments ti be shared then please tick here:

Thank you for filling in our form.

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01206 484 101

admin@gpprimarychoice.co.uk

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Modern Slavery Statement

Unit 1, Block C, University of Essex, Knowledge Gateway, Parkside Office Village, Nesfield Road, Colchester, Essex, CO4 3ZL

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