Park Surgery

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?

Very likely

Unlikely

Neither likely nor unlikely

Unlikely

Very unlikely

Don't know

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

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

Very good

Good

Neither good nor poor

Poor

Very poor

Don't know

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;

Male

Female

Intersex

Non-binary

Prefer not to say

Own gender identity

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

Yes

No

Prefer not to say

Age:

16-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65 or over

Prefer not to say

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;

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background

Prefer not to say

Black, African, Caribbean or Black British;

African

Caribbean

Any other Black, African or Caribbean background

Prefer not to say

Mixed or multiple ethnic groups;

White and Black Caribbean

White and Black African

White and Asian

Any other mixed or multiple ethnic background

Prefer not to say

White;

English

Welsh

Scottish

Northern Irish

Irish

British

Gypsy or Irish Traveller

Any other White background

Prefer not to say

Other ethnic group;

Arab

Other ethnic group

Prefer not to say

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

Yes

No

Prefer not to say

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

Religion or belief;

No religion or belief

Hindu

Sikh

Buddhist

Jewish

Christian

Muslim

Other religion or belief

Prefer not to say

Do you work?

Yes

No

Prefer not to say

If yes, what is your work pattern?

Full-time

Part-time

Prefer not to say

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

None

Primary carer of a child/children (under 18)

Primary carer of a disabled child/children

Primary carer of a disabled adult/adults (18 and over)

Primary carer of an older person

Secondary carer (another person carries out the main caring role)

Other

Prefer not to say

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

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