|
Always complete this section
|
|
About you |
How old are you? |
|
Gender |
Male
Female
|
Post code |
|
How long have you been our patient? |
|
How many times have you used our services in the last year? |
|
Name (optional) |
|
Email (optional) |
|
|
|
Please complete as
many of the following
sections as you wish to send feedback about. |
|
|
Tell us what we have done well... |
|
What did we get right?
|
|
Tell us what we have done not so well... |
|
What did we get wrong?
|
|
Registration |
| How satisfied were you with the registration process? |
|
| What do you think we could do better? |
|
|
Booking an appointment |
How satisfied were you with the booking process? |
|
| How did you book your appointment? |
|
| What do you think we could do better? |
|
|
Seeing a doctor |
Can you recall the last doctor you saw? |
|
How satisfied were you with the consultation? |
|
| What do you think we could do better? |
|
|
Seeing a nurse practitioner (Sr. Maggie
Williams) |
How satisfied were you with the consultation? |
|
| What do you think we could do better? |
|
|
Seeing a nurse |
Can you recall which nurse you saw? |
|
How satisfied were you with the consultation? |
|
| What do you think we could do better? |
|
|
Ordering a repeat prescription |
When did you last order a repeat prescription? |
|
How did you make your request for the repeat? |
|
How satisfied were you with the repeat ordering process? |
|
| What do you think we could do better? |
|
| Final comments |
Please use this area to add any other comments: |
|
