* 1. Please indicate which of the following applied to you.

* 2. At the time of your referral, were you aware that your GP should have discussed the choice of appropriate hospitals/clinics available for you to receive treatment at?

* 3. At the time of your referral, did your GP discuss a choice of hospital for treatment with you?

* 4. Which was your first choice of hospital for treatment?

* 5. What were your main reasons for your first choice of hospital (even if you were not able to go there)?

* 6. How long after you left your GP did you attempt to book your appointment?

* 7. If you waited before booking your appointment, what were your reasons?

* 8. Were you able to go to your first choice of hospital?

* 9. How did you book your first hospital appointment?

* 10. Did any of the following apply to you while you were arranging your first hospital appointment?

* 11. How easy was it to arrange your first hospital appointment?

* 12. How soon was your appointment booked for?

* 13. When your first appointment was made, were you offered a choice of different dates and /or times of day?

* 14. Were the dates and/or time of day offered convenient?

* 15. Was the appointment either cancelled or rearranged by:

* 16. Did you find it easy or difficult to cancel or rearrange your appointment?

* 17. Are you (the patient) male or female?

* 18. How old are you (the patient)?

* 19. Do you have any children?

* 20. How old are your children?

* 21. Please provide the postcode of where you live?

* 22. What is the name of the pratice where you see your GP?

* 23. Have you ever served in the Arm Forces?

* 24. Are you an immediate family member of somebody who has served in the Armed Forces?

* 25. Are you aware of your rights as a member of the Armed Forces/ your family?

* 26. To which of these ethnic groups would you say you belong?

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