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50% of survey complete.
Understanding what patients and their families think about the service we provide is very important to gtd healthcare. If you have any comments or suggestions, please take a few minutes to complete this questionnaire. Any information you provide will be treated in confidence and with sensitivity. This questionnaire is anonymous and you are under no obligation to provide your contact details.

The questionnaire is separated into different sections depending on the type of care you have received for example homecare advice or a home visit. The fields are optional so you can leave any of them blank if you feel they do not apply to you.

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* 1. How likely are you to recommend our service to friends and family if they needed similar care or treatment?

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* 2. Are you:

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* 3. What area do you live in?

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* 4. If contacted NHS111 was the patient:

This survey is separated into different sections depending on the type of care the patient received.  Please complete the sections that apply to the patient.
Section 1 - Telephone Advice

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* 5. Telephone advice

  Yes Partly No
Did you feel the time you waited for a call back was acceptable?
Did the doctor/nurse introduce themselves?
Was the doctor/nurse you spoke to polite and courteous?
Did you feel the doctor/nurse listened to you?
In your opinion did the doctor/nurse understand your problem?
Did you feel reassured by the doctor/nurse?
Were you happy with the advice you received?
Section 2 - Treatment Centre

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* 6. Which treatment centre did you attend?

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* 7. Was the treatment centre environment clean and tidy?

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* 8. If you travelled to the treatment centre by car were you satisfied with the car parks?

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* 9. If given an appointment time, how long did you have to wait to be seen by a doctor?

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* 10. Treatment centre appointment

  Yes Partly No N/A
Did you feel the distance you had to travel to the treatment centre was acceptable?
Did the receptionist greet you on arrival?
Was the receptionist polite and courteous?
If there was a delay did the receptionist keep you updated on the waiting times?
Did the doctor/nurse you saw introduce themselves?
Was the doctor/nurse you saw polite and courteous?
Did you feel the doctor/nurse listened to you?
In your opinion did the doctor/nurse understand your problem?
Did you feel reassured by the doctor/nurse?
Were you happy with the advice you received?
Section 3 - Home visit

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* 11. Home visit

  Yes No
Were you told how long it would be before a doctor could visit you at home?
If the home visit took longer than you were initially told, were you kept informed by a member of gtd healthcare's staff?

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* 12. Approximately how long did you have to wait for the doctor to arrive?

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* 13. Home visit

  Yes Partly No
Were you satisfied with the time you waited for the home visit?
Did the doctor you saw introduce themselves?
Was the doctor you saw polite and courteous?
Did you feel the doctor listened to you?
In your opinion did the doctor understand your problem?
Did you feel reassured by the doctor?
Were you happy with the advice you received?
Section 4 - Overall service

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* 14. Overall service

  Yes Partly No
Were you treated with dignity and respect from all our employees?
Were you satisfied with the overall care you received?

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* 15. What do you feel gtd healthcare did well?

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* 16. What do you feel gtd healthcare could do better?

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* 17. Please enter any additional comments:

Section 5 - Equality & Diversity Monitoring
We want to make sure that the services we provide are fair to all who need them.  Your feedback will help us get a picture of the people who access our services.  It also identifies those who do not access our services; completing these questions will help us reduce potential barriers to accessing healthcare.

We would be grateful if you could take a little time to complete this form.  Please go through it and tick all the categories that most accurately describe you.  Some questions may feel personal, but the information we collect will be kept confidential and secure.

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* 18. Patient's Age (please tick one box)

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* 19. What best describes your gender?

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* 20. Is your gender identity the same as the one you were assigned at birth?

Disability

Under the Equality Act 2010, a person is considered to have a disability if they have a physical or mental impairment which has a substantial or long-term adverse effect on their ability to carry out normal day-to-day activities.  In order to be able to identify and respond to a patient's specific needs, it is important that we know what disability you have.

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* 21. Do you consider yourself to be disabled/have an impairment?

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* 22. If you have answered yes please tick the box/es below that best describe your disability/impairment.

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* 23. Are you a carer?

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* 24. Ethnicity

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* 25. Belief/Religion

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* 26. Language

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* 27. Sexual Orientation
Which of the following best describes how you think of yourself?

Pregnancy & Maternity

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* 28. Are you pregnant?

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* 29. Have you had a baby in the last 12 months?

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* 30. Marriage & Civil Partnership

Refugees & Asylum Seekers

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* 31. Are you a Refugee?

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* 32. Are you an Asylum Seeker?

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* 33. Which country or region are you a refugee/asylum seeker from?

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