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Toggle Navigation
Home
About Us
Our Services
Specialist Social Prescribers
Home Visits
Welfare Benefits
Blue Badge Applications
Primary Enhanced Services (PES)
Phlebotomy (Blood Tests)
Targeted Lung Health Checks
Community Skin Lesion/Mole Clinic
ECG Fitting
Spirometry
Governance
Infection Control
Forms & Surveys
Contact Us
Friends and Family Test
James Coxon
2024-06-13T10:56:43+00:00
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
No
If yes, could you give some details?
Which of the following best describes your ethnic background?
*
White British
White Irish
Other White Background
Asian or Asian British: Indian
Asian or Asian British: Pakistani
Asian or Asian British: Bangladeshi
Asian or Asian British: Chinese
Other Asian background
Mixed: White and Black Caribbean
Mixed: White and Black African
Mixed: White and Asian
Other Mixed Background
Black or Black British: Caribbean
Black or Black British: African
Other Black Background
Anything else
I would rather not say
Are you?
*
The patient
The parent or carer
The Patient and parent/carer
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:
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