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
Could we have improved your visit today?
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Additional Questions
How approachable do you find our receptionists?
Very approachable
Quite approachable
Neither approachable nor unapproachable
Not very approachable
Completely unapproachable
How helpful do you find our receptionists?
Extremely helpful
Quite helpful
Quite unhelpful
Not at all helpful
Can you please let us know if you are male or female?
Male
Female
What is your ethnic background?
White
Mixed/Multiple ethnic groups
Black / African /Caribbean / Black British
Asian / Asian British
Chinese
Other ethnic group
How old are you?
0 - 15
16 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 - 74
75 - 84
85+
Are your day to day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 23 months? (include any issues/problems related to old age)
Yes limited a lot
Yes limited a little
No
Prefer not to say
Did you have support to fill in this questionnaire?
Yes
No
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