Proposed Merger

The Proposed Merger between Plumstead Health Centre and Trinity Medical Centre

This is Patient Questionnaire to help shape the proposed Merger between the two Practices. We appreciate your time completing this form - Thank you

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* 1. Are you a patient of Plumstead Health Centre or Trinity Medical Centre PMS?

Plumstead Health Centre

Trinity Medical Centre

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* 2. Do you support the proposal to merge Plumstead Health Centre and Trinity Medical Centre PMS?

Yes

Don't know

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* 3. How do you think this merger will affect you or your family?

The merger will have a positive impact

The merger will have a negative impact

The merger will have no significant impact

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* 4. What are your overall views on the merger?

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* 5. Please give us your views on how we can make this merger as straightforward and as smooth as possible for patients

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* 6. Are there any other comments you would like to make?

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* 7. What gender are you?

Male

Female

Non binary

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* 8. What age group are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 9. What is your ethnicity?

White (British, Irish , European, Any other White background)

Black or Black British ( Caribbean , African Any other Black / African / Caribbean background)

Hispanic or Latino (South or Central American)

Asian or Asian British (Indian Pakistani, Bangladeshi, Sri Lankan, Chinese, Any other Asian Background)

Mixed / Multiple ethnic groups (White / Black Caribbean, White / Black African, White and Asian or any other Mixed/

Multiple ethnic background

Native Hawaiian or other Pacific Islander

Arab / Middle East / Any other Ethnic Group

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* 10. Do you have a Long Term Condition ? (Such as Diabetes, Asthma, Chronic Heart Disease or any other) and are you registered disabled?

Yes

Don't Know

Yes and Registered Disabled

No and Registered Disabled