The Practice Ophthalmology Bucks Patient feedback questionnaire Question Title * 1. Please select where you had your appointment: Chalfont and Gerrards Cross Hospital, Chalfont St Peter Cross Keys Surgery, Princes Risborough Poplar Grove Surgery, Aylesbury The Practice Hanover House, High Wycombe The Practice Prospect House, Great Missenden Verney Close Surgery, Buckingham Other (please state) Other (please specify) Question Title * 2. Are you Patient Carer Question Title * 3. The attitude and helpfulness of the staff when booking your appointment Unsatisfactory Poor Average Good Very Good Unsatisfactory Poor Average Good Very Good Question Title * 4. 2. The quality of literature you received regarding your appointment e.g. letter, leaflet, map, etc. Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 5. Waiting time for an appointment Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 6. The ease of finding the clinic Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 7. Access to the clinic (parking, disabled access) Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 8. The speed in which you were seen on the day Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 9. The environment and patient facilities at the clinic e.g. toilets, waiting area, etc Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 10. The attitude of the doctor Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 11. How well the doctor listened to you Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 12. Explanation of your treatment Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 13. Explanation of follow-up treatment plan Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 14. Info on who to contact if you have a problem Unsatisfactory Poor Average Good Very Good Unsatisfactory Poor Average Good Very Good Question Title * 15. Overall consultation satisfaction Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 16. How likely are you to recommend the service to friends or family? Unsatisfactory Poor Average Good Very good Unsatisfactory Poor Average Good Very good Question Title * 17. Comments: (please leave your name and phone number if you would like us to contact you regarding your comments) Done