Victoria Medical Centre
Patient Satisfaction Questionnaire

The importance of Patient Satisfaction is a key performance factor of this surgery and its staff.  In order to continue to improve our service to our patients we would request a few moments of your time to complete this form.

If you would like further information on any of the points raised please discuss this with a member of our reception team who will be more than willing to help.

Please tick the appropriate box:  			Are you filling this in for:

 Yourself		Your Child		Your spouse or partner		Another relative or friend		

Q1: What is the reason you have attended the surgery today? Please delete as appropriate

A: To ask for advice	  B: To make an appointment
C: To see a Doctor for a pre-arranged appointment	D: To pick up Prescriptions		
E: To see a Nurse	F: For a Blood Test	 G: Other

Q2: Where you seen promptly and dealt with in a way that satisfied your needs and        expectations? 

       Yes / No (Delete as applicable) If No please give reason(s)

	

Q3: Were you satisfied with the information / Response from the Reception Staff?  

       Yes / No (Delete as applicable) If No please give reason(s)

	

Q4: If necessary were you given the opportunity to speak with someone in private?

      Yes / No

Q5: If seen by a Doctor or Nurse do you consider they listened to your concerns and fully        understood the reason for your visit?

      Yes / No (Delete as applicable) If No please give reason(s)

	

Q6: If attending for an appointment did the outcome address your medical needs to your        expectations? 

       Yes / No (Delete as applicable) If No please give reason(s)

	

Q7: Were you treated with respect and confidentiality?

       Yes / No (Delete as applicable) If No please give reason(s)

	

Q8: Are you aware that the Surgery has a Patients Participation Panel

       Yes / No: If you would like further information on this please contact a member of the        reception team.

Q9: Would you recommend the service to family and friends?

       Yes / No

Q10: Please add any further comments or suggestions you may have in order to improve our          service.  

	

Q11: Information about you?

Are you:		 Male / Female
Your age: 		Optional
Your Ethnicity 	Optional

If you would like someone to contact you with regards to any aspect of your care or treatment please enter your contact details below and thank you for taking the time to complete this survey.

Name: 				Contact details: