Friends & Family Test
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How likely are you to recommend our GP Surgery to friends and family if they needed similar care or treatment?
Extremely Likely
Likely
Neither Likely nor Unlikely
Unlikely
Extremely Unlikely
Don't Know
Can you tell us why you gave that response?
Tick this box if you consent to us publishing your comment anonymously on our website.
Additional Questions
This section is for information only and there is no need to write anything in the Free text box on the right. Below are some questions to help us find out a bit more about you. Different groups of patients may have different needs and that we make sure we hear from everybody. The Equality Act 2010 defines some of the questions we need to ask.
How often do you use our service?
Regularly
Occasionally
Very Rarely
Do you have a longstanding health condition?
Yes
No
Do you consider yourself to have a disability?
Yes
No
Which of the following best describes you? you can choose more than one answer
Employed (full or part time including self-employed)
Unemployed / looking for work
At school or in full time education
Unable to work due to long term sickness
Looking after your home/family
Retired from paid work
Other
Do you provide free care, help or support for a family member, friend or neighbour who is vulnerable, disabled, or elderly?
yes one or two hours per week
yes several hours per week
yes full time
yes - other
No
Are you?
Male
Female
Other / not sure
What age are you? (Age is a protected characteristic under the Equality Act 2010)
0-15
16-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
What is the ethnic background with which you most identify? (Ethnicity is a protected characteristic under the Equality Act 2010)
White British
White Irish
Mixed White & Black Caribbean
Mixed White & Black African
Mixed White & Black Asian
Indian
Pakistani
Bangladeshi
Black Caribbean
Black African
Chinese
Other
Do not wish to say
Which of the following best describes your sexual orientation? (Sexual orientation is a protected characteristic under the Equality Act 2010)
Heterosexual / straight
Gay / Lesbian / Homosexual
Bisexual
Other / not sure
Do not wish to say
Which of the following best describes your religion? (Religion is a protected characteristic under the Equality Act 2010)
Atheist / not religious
Agnostic / no particular religion
Buddhist
Christian all denominations including Catholic
Hindu
Jewish
Muslim
Other
Do not wish to say
Thank you very much for taking the time to complete this survey. Please press SUBMIT TEST button below to complete your survey. We will publish the results on our website and comments will be shared with our Patient Group to help us improve services. This section is for information only and there is no need to write anything in the Free Text box on the right.
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