Brockhurst Patient Survey

Question Title

* 1. Are you registered as a patient at Brockhurst Medical Centre?

Yes – just me

Yes – and my family is

No – I am a carer for a patient at Brockhurst Medical Centre?

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* 2. Roughly how often do you use Brockhurst Medical Centre?

Once a week

Once a fortnight

Once a month

Once or twice a year

Less often

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* 3. How do you usually travel to this surgery?

By foot

Own car

Public Transport

Taxi

Bicycle

Other (please specify)

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* 4. Approximately how long does it usually take you to get to the surgery?

Less than 10 minutes

More than 10 minutes but less than 15 minutes

More than 15 minutes

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* 5. If you have not used the surgery over the last year, why is this?

Opening hours

Difficult access

No need to go to the Doctors

Services not provided

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* 6. Which of the available services would you say you most often use at the surgery?

Appointment with a GP – (including face-to-face, telephone or online eg eConsult or Skye or similar)

Appointment with a Nurse – (including face-to-face, telephone or online eg eConsult or Skye or similar)

Ante-natal services

Regular blood tests

Minor Surgery

Vaccination clinics

Other

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* 7. What is important to you in receiving a service from your surgery? Please rank 1 - 5 where 1 is most important and 5 least important.

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* 8. Are you

Male

Female

Prefer not to say

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* 9. Your age

17 or under

18-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

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* 10. Your ethnic background

Indian

Pakistani

Bangladeshi

Nepali

Asian background

Black Caribbean

Black African

Any other Black background

Chinese

White and Black Caribbean

White and Black African

White and Asian

White British

White Irish

Any other white background

Prefer not to say

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* 11. Are you a carer?

Yes for a child/children under 18 years living at home

Yes, for a relative or person living with you

Yes, for a relative or person living elsewhere

Thank you for taking the time to complete this survey.

Brockhurst Patient Survey

Question Title

* 1. Are you registered as a patient at Brockhurst Medical Centre?

Question Title

* 2. Roughly how often do you use Brockhurst Medical Centre?

Question Title

* 3. How do you usually travel to this surgery?

Question Title

* 4. Approximately how long does it usually take you to get to the surgery?

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* 5. If you have not used the surgery over the last year, why is this?

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* 6. Which of the available services would you say you most often use at the surgery?

Question Title

* 7. What is important to you in receiving a service from your surgery? Please rank 1 - 5 where 1 is most important and 5 least important.﻿

Question Title

* 8. Are you

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* 9. Your age

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* 10. Your ethnic background

Question Title

* 11. Are you a carer?

* 7. What is important to you in receiving a service from your surgery? Please rank 1 - 5 where 1 is most important and 5 least important.