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Friends and Family Test

Crosland Moor Surgery

Friends and Family Test

 

Thank you for visiting us today.

We value your feedback and would like you to think about your experience using our services.

 

Q 1. How likely are you to recommend our GP Practice to friends and family if they need similar care or treatment?

 

Extremely Likely

Likely

Neither Likely or Unlikely

Unlikely

Extremely Unlikely

Don’t Know

 

Could you please tell us the reason for the answer you have given?

 

I do not wish this second response to be included in any publications or reports

 

Q 2. What was good about your visit today?

 

 

 

Your response to these questions will contribute to our Family & Friends Test score, which is shared with the public through the waiting room display, the PPT, practice newsletter and website

 

I do not wish this second response to be included in any publications or reports

…………………………………………

Equality and Diversity data (Internal Use only)

We would like to know more about you for our own analysis so we can ensure that we are helping our local population – we won’t share this information with anyone else.

 

Please tick the relevant boxes;

 

Male

Female

 

Age Group:

 

16 - 24

25 - 34

35 - 44

45 – 54

55 – 64

65 – 70

70+

 

Thank you for your Feedback – please return this form to reception



 
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