Patient Survey

Licensed doctors are expected to seek feedback from colleagues, patients and reviews and act upon that feedback where appropriate.

The purpose of this exercise is to provide doctors with information about their work through the eyes of those they work with and treat, and is intended to help inform their further development.

Please do not provide your name in this questionnaire.

Please base your answers only on the consultation you have had today.

If you are filling in this in for someone else, please answer the following questions from the patient's point of view.

Please note: no patients will be identified when this information is given to the doctor.

Patient Survey
Which of the following best describes the reason you saw the doctor today? (Please tick all the boxes that apply)
On a scale of 1 to 5, how important to your health and wellbeing was your reason for visiting the doctor today?
How good was your Doctor today at each of the following:
Being polite
Making you feel at ease
Listening to you:
Assessing your medical condition
Explaining your condition and treatment
Providing or arranging treatment for you
Please decide how strongly you agree or disagree with the following statements by ticking ONE box
This Doctor will keep information about me confidentiall
This Doctor is honest and trustworthy
I am confident aboug this Doctor's ability to provide care
I would be completely happy to see this Doctor again

Privacy Protection

Information entered into survey forms is used only for the purposes of processing your survey information and is stored and accessed securely by designated staff.

Issues raised in comments may be discussed between relevant members of staff. The information is used for quality monitoring purposes, in line with the expectations of those submitting the feedback.

Any personal information transmitted via survey forms may be anonymised when this is required to ensure compliance with General Data Protection Regulation.

This information is not shared with any external third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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