PCN Survey

Age

 
 
 
 
 
 
 
 

Ethnic Group

 
 
 
 
 
 

Employment Status

 
 
 
 
 
 
 
 

Preferred method of travel to the GP surgery

 
 
 
 
 
 

Do you find it difficult to attend appointments, in person or by telephone during the hours of 8.00am – 6.30pm Monday – Friday?

 
 

If yes, please indicate why this is:

Have to ever attended an appointment, in person or by telephone in out of hours (ie after 6.30 Monday to Friday or on a Saturday morning?

 
 

Would you be willing to attend an out of hours appointment, even if they were not at your usual surgery?

 
 

Which of the following would you find the most useful?

 
 
 
 
 

The new service must provide a GP clinic alongside other healthcare professional, please select what other services you would like us to set up.

 
 
 
 
 
 
 

Which of the following would you find the most useful?

 
 
 
 
 
 
 

Are you aware we offer virtual appointments as well as face to face? Virtual appointments can be by telephone or video call.

 
 

What GP Practice are you registered at?

 
 
 

Are you registered disabled?