CHRISP STREET HEALTH CENTRE SURVEY including the Friends & Family Test

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* 1. We would like you to think about your recent experience of our service. How likely are you to recommend our service to friends and family if they need similar care or treatment? (tick one box)

Extremely likely

Likely

Neither likely nor unlikely

Unlikely

Extremely unlikely

Don’t know

Can you tell us why you gave that response?

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* 2. In addition, please rate how satisfied you are with the following … (tick one box in each row)

	Very satisfied	Fairly Satisfied	Neither Satisfied nor Dissatisfied	Not Satisfied	Very Unsatisfied	Don’t Know
Phone answering	Phone answering Very satisfied	Phone answering Fairly Satisfied	Phone answering Neither Satisfied nor Dissatisfied	Phone answering Not Satisfied	Phone answering Very Unsatisfied	Phone answering Don’t Know
Customer care	Customer care Very satisfied	Customer care Fairly Satisfied	Customer care Neither Satisfied nor Dissatisfied	Customer care Not Satisfied	Customer care Very Unsatisfied	Customer care Don’t Know
Online services	Online services Very satisfied	Online services Fairly Satisfied	Online services Neither Satisfied nor Dissatisfied	Online services Not Satisfied	Online services Very Unsatisfied	Online services Don’t Know
Getting same day care, through our telephone call back system (Triage)	Getting same day care, through our telephone call back system (Triage) Very satisfied	Getting same day care, through our telephone call back system (Triage) Fairly Satisfied	Getting same day care, through our telephone call back system (Triage) Neither Satisfied nor Dissatisfied	Getting same day care, through our telephone call back system (Triage) Not Satisfied	Getting same day care, through our telephone call back system (Triage) Very Unsatisfied	Getting same day care, through our telephone call back system (Triage) Don’t Know
Having a named GP	Having a named GP Very satisfied	Having a named GP Fairly Satisfied	Having a named GP Neither Satisfied nor Dissatisfied	Having a named GP Not Satisfied	Having a named GP Very Unsatisfied	Having a named GP Don’t Know
Seeing your own GP	Seeing your own GP Very satisfied	Seeing your own GP Fairly Satisfied	Seeing your own GP Neither Satisfied nor Dissatisfied	Seeing your own GP Not Satisfied	Seeing your own GP Very Unsatisfied	Seeing your own GP Don’t Know
Nursing Services	Nursing Services Very satisfied	Nursing Services Fairly Satisfied	Nursing Services Neither Satisfied nor Dissatisfied	Nursing Services Not Satisfied	Nursing Services Very Unsatisfied	Nursing Services Don’t Know
Waiting time for your appointment on arrival	Waiting time for your appointment on arrival Very satisfied	Waiting time for your appointment on arrival Fairly Satisfied	Waiting time for your appointment on arrival Neither Satisfied nor Dissatisfied	Waiting time for your appointment on arrival Not Satisfied	Waiting time for your appointment on arrival Very Unsatisfied	Waiting time for your appointment on arrival Don’t Know
Registration	Registration Very satisfied	Registration Fairly Satisfied	Registration Neither Satisfied nor Dissatisfied	Registration Not Satisfied	Registration Very Unsatisfied	Registration Don’t Know
Facilities	Facilities Very satisfied	Facilities Fairly Satisfied	Facilities Neither Satisfied nor Dissatisfied	Facilities Not Satisfied	Facilities Very Unsatisfied	Facilities Don’t Know
Other services e.g. midwife, alcohol/drugs, psychology, benefits	Other services e.g. midwife, alcohol/drugs, psychology, benefits Very satisfied	Other services e.g. midwife, alcohol/drugs, psychology, benefits Fairly Satisfied	Other services e.g. midwife, alcohol/drugs, psychology, benefits Neither Satisfied nor Dissatisfied	Other services e.g. midwife, alcohol/drugs, psychology, benefits Not Satisfied	Other services e.g. midwife, alcohol/drugs, psychology, benefits Very Unsatisfied	Other services e.g. midwife, alcohol/drugs, psychology, benefits Don’t Know

Any comments about the above?

Some information about you...

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* 3. Please state your Ethnicity

White British

White Irish

Other white background

Bangladeshi

Pakistani

Indian

Chinese

Other Asian background

Mixed White & Black Caribbean

Mixed White & Black African

Mixed White & Asian

Other mixed background

Black African

Black Caribbean

Somali

Other (please specify)

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* 4. Are you

Male

Female

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* 5. What age are you?

0-15

16-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

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* 6. Do you consider yourself to have a disability?

Yes

Other (please specify)

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* 7. Are you?

a current Patient

a current Parent or Carer

a current Patient and Parent/Carer

none of the above

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* 8. Thank you for completing the survey and providing us with feedback to improve our services. If you do NOT wish us to share your anonymous comments, please tick the box below.

I would prefer you NOT to share my anonymous comments