* 1. Are you aware of how to contact the Out of Hours GP service when the surgery is closed?

* 2. In the past 6 months, have you tried to call an Out of Hours GP service or attend the A&E department when the surgery was closed?

* 3. In the past 6 months, if you have had to attend A&E at the hospital, why did you need to do so? Choose one or more...

* 4. Answering YES or NO please tick below for any of the services that you are aware of or have knowledge about, when dealing with Out of Hours Care

NHS Direct Website
Pharmacy minor ailments eg Alisha Pharmacy and Roxanne's
Walk in Centres eg Featherstone Clinic Southall 8 - 8pm
NHS 111
Urgent Care Centre eg Ealing and Brent Urgent care centre
NHS choices website

* 5. Which of the following appointment types at this surgery do you have knowledge about?

Same day emergency appointments morning and afternoon
Telephone consultations morning and afternoon
Home visit appointments
48 Hour appointment slots
Friday afternoon walk in emergency session
6 week advance bookable appointments
Online advance appointment bookings
Saturday mornings (once a month)

* 6. How helpful did you find the receptionists at the surgery on your last visit or phone call?

* 7. Which of the following areas with regard to the waiting room / reception area would you like to see changes in?

Seating area needs to be more comfortable
Choice of music
Better privacy at the front desk
Bike rack outside the surgery
More notices or information to refer to in the waiting room

* 8. Which of the following services are you aware of with regard to your REPEAT PRESCRIPTIONS / medications?

Online prescription request with secure log in
24 hour / late night pharmacy in local area
Dossett Prescribing
Batch prescribing
Prescription request via designated pharmacy
Website prescription request system
How to get rid of unused medication
How to synchronise repeat medication

* 9. Would you be interested in coming to the surgery for Health Check Programmes / Reviews which were not part of the National chronic disease programme? Examples would be aneurysms, sexual health, obesity, MI, HIV related checks, headaches management, Irritable bowel syndrome etc?

* 10. Are you aware of the surgery's complaints procedures?