* 1. How do you usually make appointments to see a doctor or nurse?

* 2. How helpful are the receptionists at your practice?

* 3. How easy do you find the following

  Very easy Fairly easy Not very easy Never tried
Getting through on the phone
Speaking to a doctor on the phone
Speaking to a nurse on the phone
Obtaining test results
URGENT same day appointment
Book appointments ahead

* 4. If you wish to see a named doctor how quickly are you able to be seen?

* 5. How satisfied are you with the opening hours at the surgery?

* 6. How satisfied were you with your last appointment with a doctor at the surgery?

  Very satisfied Fairly satisfied Dissatisfied N/A
Asked about your symptoms
Listened to you
Explained about tests & treatments
Involved you in decisions about your care
Treat you with care and respect
Took your problems seriously

* 7. Telephone consultations

  Yes No
Did you know you can book a telephone consultation with a doctor at your practice?
Have you ever had a telephone consultation?
Would you use a telephone consultation again?

* 8. Please rate your last appointment with an Advanced Nurse Practitioner at the surgery

  Very satisfied Fairly satisfied Dissatisfied N/A
Asked about your symptoms
Listened to you
Explained about tests / treatments
Involved you in decisions about your care
Treat you with care and respect
Took your problems seriously

* 9. Please rate your last appointment with an Practice Nurse at the surgery

  Very satisfied Fairly satisfied Dissatisfied N/A
Asked about your symptoms
Listened to you
Explained about tests / treatments
Involved you in decisions about your care
Treat you with care and respect
Took your problems seriously

* 10. Please rate your last appointment with a Health Care Assistant at the surgery

  Very satisfied Fairly satisfied Dissatisfied N/A
Asked about your symptoms
Listened to you
Explained about tests / treatments
Involved you in decisions about your care
Treat you with care and respect
Took your problems seriously

* 11. Regarding your practice building

  Very Fairly Not very Not at all
How clean is the surgery?
How comfortable is the waiting area?
How clear are the signs inside the building?

* 12. In general are you satisfied with the service provided by the practice?

* 13. Do you have any suggestions how the practice can make any improvements to their service?

* 14. Would you recommend the practice to someone who has just moved into the area?

* 15. Did you know that you can book an appointment with a doctor and order repeat medication on-line via our website? (an account is needed, ask for details at reception)

www.jubileemedical.co.uk

* 16. Have you been seen at the practice having booked the appointment via the 111 service in the last 12 months?

* 17. In what format would you like to receive information about the practice?

* 18. Are you

* 19. How old are you?

* 20. What is your ethnic group

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