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Friends and Family Test
We would like you to think about your recent experience of our service .
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Thinking about your GP practice overall , How was your experience of our service ?
*
Very Good
Good
Neither good nor poor
Poor
Very Poor
Don't know
MAKING APPOINTMENTS
How long after contacting the surgery did you have your appointment ?
On the same day
Next working day
A few days later
A week or more
Other
Clear selection
Overall , how would you describe your experience of making an appointment ?
Very Bad
1
2
3
4
5
Very Easy
Clear selection
WAITING TIMES
Generally , How easy it to get through to someone at your GP practice on phones?
Poor
1
2
3
4
5
Very Good
Clear selection
How happy are you to use the check-in Screen ?
Least confident
1
2
3
4
5
Extremely confident
Clear selection
Do you use the check-in screen when you arrive for your appointment ?
Yes
No
Clear selection
Would you like someone to support you on this ?
Choose
Yes
No
MEDICATION REQUEST
Do you know you can order your medication online ?
Yes
No - I don't want to
No - But I would like to in future and want more information
Clear selection
MEDICAL RECORDS
Are you aware you can view your medical records online ?
Aware and use this service
Not Aware
Aware but don't use this service
Clear selection
ONLINE APPOINTMENT BOOKINGS ( PATCHS)
Have your submitted a request for online consultations through PATCHS?
Yes
No
Clear selection
Do you have access to Internet at home ?
Yes
No
Clear selection
How confident are you with using GP online services ?
Least confident
1
2
3
4
5
Extremely confident
Clear selection
ABOUT YOURSELF
Are you ?
Male
Female
Intersex
Prefer not to say
Other:
Clear selection
What age group are you ?
Column 1
Under 16
16-24
25-34
35-44
45- 54
55- 64
65-74
75 -84
85 Plus
Column 1
Under 16
16-24
25-34
35-44
45- 54
55- 64
65-74
75 -84
85 Plus
Ethnicity
White
Mixed/ Multiple Ethnic group
Asian/Asian British
Black/African/Caribbean/Black British
Other Ethnic group
Clear selection
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