The Junction Patient Experience Questionnaire

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* 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

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* 2. How would you rate your overall experience of using this service today?

Excellent

Very good

Good

Satisfactory

Poor

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* 3. How much confidence and trust do you have in the Doctor/Nurse that treated you today?

1 - No confidence

6 - Complete confidence

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* 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

Don’t know/can’t remember

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* 5. Did your Doctor/Nurse treat you with respect and dignity?

Yes, all the time

Yes, some of the time

Don’t know/can’t remember

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* 6. Please leave the name of the Doctor/Nurse that you were seen by today

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* 7. Did any of our staff make your experience particularly good today, if so please let us know?

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* 8. How could we improve our service?

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* 9. Are you satisfied with our opening hours of the service?

Yes

If no, please comment

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* 10. Are happy with the availability of appointments?

Yes

If no, please comment

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* 11. Patient details (optional)

Your name:

Your telephone:

Your email:

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* 12. Patient gender (optional)

Male

Female