Park Surgery Ultrasound Survey

Park Surgery works hard to meet the aims and commitments set out in its equality policy. This includes not discriminating under the Equality Act 2010 and building an accurate picture of the make-up of our patients, encouraging equality and diversity.

We need your help and co-operation to enable us to do this and ask that you take a couple of minutes to complete this survey for us. Completion of this survey is voluntary and the information provided will be kept confidential, adhering to GDPR guidance and will be used for monitoring purposes only.

If you have any questions about the survey please email Park Surgery Ultrasound Department at sxicb-wsx.parksurgeryultrasound@nhs.net or call them on 01403 214665/01403 214633.

1. Thinking about your recent ultrasound scan at Park Surgery Horsham, how likely would you be to recommend our service to friends or family if they needed similar care?

 
 
 
 
 
 

2. Thinking about your response, what is the main reason you feel this way?

3. Overall, how was your experience of our service?

 
 
 
 
 
 

4. Please can you tell us why you gave this answer?

5. Was there anything we did particularly well or that we could have done better?

6. During your visit did any member of staff go above and beyond your expectations?

Information about your Gender;

 
 
 
 
 
 

Is the gender you identify with the same as your gender registered at birth?

 
 
 

Age:

 
 
 
 
 
 
 
 
 
 
 

Ethnicity: Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box;

Asian or Asian British;

 
 
 
 
 
 

Black, African, Caribbean or Black British;

 
 
 
 

Mixed or multiple ethnic groups;

 
 
 
 
 

White;

 
 
 
 
 
 
 
 
 

Other ethnic group;

 
 
 

Do you consider yourself to have a disability or health condition?

 
 
 

Is there anything else we can do to improve accessibility to our service?

Religion or belief;

 
 
 
 
 
 
 
 
 

Do you work?

 
 
 

If yes, what is your work pattern?

 
 
 

Caring responsibilities? If yes, please tick all that apply;

 
 
 
 
 
 
 
 

Were appointment times flexible to work around your work pattern/family/carer needs?

***Thank you for taking the time to complete this survey***