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Diabetes Community Services
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1.
Question 1.
Which GP Practice are you registered with?
1. Furnace Green Surgery
2. Ifield Medical Practice
3. Pound Hill Medical Group
4. Woodlands & Clerklands Partnership
2.
Question 2.
Would you like to have GP and Nurse appointments available on Saturdays between 9:00 and 5:00PM at your local surgery?
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
3.
Question 3.
Would you like to have appointments in the early evening between 6:30PM and 8:00PM?
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
4.
Question 4.
Would you like to have appointments available at your GP surgery in the mornings before 08:00AM?
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
5.
Question 5.
How important are the following people to you in terms of supporting you to look after your Diabetes and your general health?
GP appointment face to face
GP appointment telephone
Nurse appointment
Health Care Assistant appointment
Not at all Important
Your Spouse / Partner / Carer
GP appointment face to face
GP appointment telephone
Nurse appointment
Health Care Assistant appointment
Not at all Important
Your Practice Nurse
GP appointment face to face
GP appointment telephone
Nurse appointment
Health Care Assistant appointment
Not at all Important
Your GP
GP appointment face to face
GP appointment telephone
Nurse appointment
Health Care Assistant appointment
Not at all Important
6.
Question 6.
Do you feel adequately involved in decisions concerning your care?
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
7.
Question 7.
Do you receive enough information about Diabetes and your own health when attending the surgery about your Diabetes?
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
8.
Question 8.
Do you feel confident in your ability to manage your Diabetes with the support you receive at the GP Surgery?
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
9.
Question 9.
Have you been on any education courses such as DAFNE (Dose Adjustment For Normal Eating – Type 1 Diabetes), DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) or EPP (Expert Patient Program)?
Yes
DAFNE
Yes
DESMOND
Yes
Expert Patient Programme (EPP)
Yes
10.
Question 10.
If your answered Yes to any of the above would you recommend the course to others?
Yes
No
Comments:
This is required
11.
Question 11.
Overall, how satisfied are you with the Diabetic Service that you receive from at your GP Practice?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Strongly Dissatisfied
Very Satisfied
Satisfied
Neutral
Dissatisfied
Strongly Dissatisfied
12.
Question 12.
Additional comments and / or suggestions to improve the care you receive