Page 1 - Friends & Family Survey - Hattersley Group Practice

gtd healthcare wants you to have the best possible care experience. The NHS Friends and Family Test is a way of gathering your feedback, so we can continually review our service.

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Are you a registered patient?

Yes

No

Which of the following services did you receive?

Telephone advice

GP appointment

Practice nurse appointment

Home visit

Video consultation

Other (please specify):

This is required

When did you use the service?

Date:

Appointment Time:

Overall how was your experience of our service?

Very good

Good

Neither good nor poor

Poor

Very Poor

Don't know

Patient's age:

Under 16

16-30

31-45

46-60

61-75

Over 75

What is your ethnic group?

White

Mixed/multiple ethnic groups

Asian/Asian British

Black/African/Caribbean/Black British

Prefer not to say

Other (please specify):

This is required

What is your gender?

Woman

Man

Non-binary

Prefer to self-describe

Prefer not to say

Do you consider yourself to have a disability?

Yes

No

Are there any other comments you would like to make about the services you received today?

From time to time, we like to publish anonymous feedback from people who use our services to help promote the benefits of gtd healthcare and celebrate the work of our team. As such, please let us know if you give permission for gtd healthcare to publish your anonymous feedback in our internal and external communications such as website, social media, newsletters, patient information and leaflets?

Yes

No

If you would like to be contacted to discuss your feedback further, please leave your details below:

Name

Address

email address

Contact telephone number