Please answer the following questions by placing a tick in the appropriate box
Q1. If you telephonedfor your appointment,how do you rate the time you waitedfor your call
to be answered?
Verv Satisfied
Satisfied
FairlvSatisfied
Not at all Satisfied
I cameto the surqeryto make my appt
Q2. Did you speakto a doctoror practicenurseon the telephonebeforeyour appointment
(often referredto as'triage')and if so how satisfiedwere you with the outcome?
Very Satisfied
Satisfied
FairlySatisfied
Not at all Satisfied
Not Applicable
Q3. How long did you haveto wait to get an appointment?
SameDav
Next WorkinqDay
Within2 WorkinqDays
Within3 WorkinqDays
Within4 WorkinqDavs
5-10 or more WorkingDays
11 or more WorkinqDays
Q4. What type of appointmentdid you havetoday?
Pre-bookedroutineappointment
SameDay appointment
Emergencysit and wait appointment
Triage by duty doctor or practicenurse
Q5. If you had an appointmentwith the doctorwas it the doctorof your choice?
Yes
No
Q6. How often do you get to see the doctorof your choice?
Always
Almostalways
Someof the time
AlmostNever
Never
Don't know
how satisfiedwere you with the way you were treated?
Q7. Thinkingaboutthe receptionist,
Verv Satisfied
Satisfied
Fairly Satisfied
Not at all Satisfied
QB,Thinkingaboutthe time you had to wait in the surgeryto see the doctor/nurse:
A. How long did you wait after your allocatedappointmenttime?
5 mtns
o r less
6-10
minutes
11-20
minutes
21-30
Over 30
m i n u t e s minutes
B. How do you rate this? (Pleasetick)
Poor
Fair
Good
Very
Good
Excellent
CareAssistant/Phlebotomist
did you see today?
Q9. WhichDoctor/Nurse/Health
Dr ColinJones
Dr Khehar
DrSingh
Dr Peiris
Dr M angar Dr Prince
GP
Reqistrar
Other
Doctor
Tina
Kim
Nick
Faye
Dr Johnson
Julie
Q 1 0 ,T h i n k i n go f y o u r c o n s u l t a t i otno d a y :
Poor
Fair
a) How thoroughwas the doctor/nurse
when askingaboutyour symptomsand
how vou were feelinq?
b) How do you rate the doctor/nurse
for listeninqto what vou had to sav?
c) How do you rate the doctor for
puttingyou at easeduringthe
consultation?
d) How do you rate the doctor/nurse
for involvingyou in decisionsabout
vour care?
e) How good was the doctor/nurse
explainingyou problemsor any
treatmentthat vou needed?
f) How do you rate the amountof time
your doctorspentwith you today?
g) How do you rate your doctor/nurse's
patiencewith any questionsor worries
you may have had?
h) How do you rate the doctor/nurse's
carinqand concernfor vou?
i) Overallhow wouldyou rate your
experiencein the practicetodav?
2
Good
Very
Good
Excellent
A. What age group are yqr In?
2G"!+5
L6-25
Over 85 yrs
66-85
46-65
B. Are you:
Male
Female
C. Howwouldyou describeyour ethnicgroup?
White
Black.sr.
BlackSritish
Asianor
Asian.British
Mixed
Chinese
Other Ethnic
Grouo
Do you have any further commentsor suggestionsto make about SnodlandMedicalPractice?
Pleaseplaceyour completedform in the box marked'PatientSatisfactionSurvey'which is
locatedon the receptiondesk.
Thankyou for taking the time to answerthis questionnaire.
The Paftners & Staff
Snodland Medical Practice