The Junction Patient Experience Questionnaire Question Title * 1. Would you recommend this service to a friend or family member? Extremely Likely Likely Neither likely or unlikely Unlikely Extremely unlikely Don't Know Question Title * 2. How would you rate your overall experience of using this service today? Excellent Very good Good Satisfactory Poor Question Title * 3. How much confidence and trust do you have in the Doctor/Nurse that treated you today? 1 - No confidence 2 3 4 5 6 - Complete confidence Question Title * 4. At your appointment/consultation did you feel that the Doctor/Nurse listened carefully to what you had to say? Yes, definitely Yes, to some extent No Don’t know/can’t remember Question Title * 5. Did your Doctor/Nurse treat you with respect and dignity? Yes, all the time Yes, some of the time No Don’t know/can’t remember Question Title * 6. Please leave the name of the Doctor/Nurse that you were seen by today Question Title * 7. Did any of our staff make your experience particularly good today, if so please let us know? Question Title * 8. How could we improve our service? Question Title * 9. Are you satisfied with our opening hours of the service? Yes No If no, please comment Question Title * 10. Are happy with the availability of appointments? Yes No If no, please comment Question Title * 11. Patient details (optional) Your name: Your telephone: Your email: Question Title * 12. Patient gender (optional) Male Female Send Questionnaire