Translating the Survey Option

This page is for information only and is not an online form.

Surrey Docks Health Centre Patient Survey

Name: (It is optional to include your name but please write your name if you wish to be included in the prize draw)

Appointments System

1. If you need to see a doctor / nurse practitioner / nurse about a more urgent matter would you prefer:

Please tick one option

A walk-in and wait system
Appointments that can be booked for the same day
No preference
Other or mixed, please specify in the box below


If other, please specify:

Please write your answer in the space below

2. If you need to see a doctor / nurse practitioner / nurse about a less urgent matter would you prefer:-

Please tick one option

A walk-in and wait system (even if there may be an even longer wait than normal)?
Appointments that can be booked for the same day only
Appointments that can be booked for a future date
No preference
Other or mixed, please specify in the box below

3. If a telephone appointment system was available would you use this system? (This is where you can speak to a doctor about your problem on the telephone instead of coming to the surgery)

Please tick one option

Yes
No (please explain in the box below why you would not use this service)
No preference

Communications between you and the practice

4. How easy is it for you to contact the surgery?

Please tick one option per row

Very Easy Quite Easy Neither Difficult or Easy Quite Difficult Very Difficult
To make an appointment?
To cancel or change an appointment?
To receive test results?
To speak to a GP / Nurse?
To speak to someone else in the practice?

5. Which of the following resources do you use to communicate with or gain information from the practice? (please select all that you use)

Please tick all that apply

Phone
Text message
Website
Automated Arrival screen
Leaflets
Posters
Receptionist

6. How important is it to you that sending and receiving information from the practice could be done by email?

Please tick one option

Essential
Very Important
Quite Important
Somewhat Important
Not at all Important

Waiting Area

7. How do you rate the following in the waiting area?

Please tick one option per row

Very Good Quite Good Neither Poor nor Good Quite Poor Very Poor
Cleanliness
Tidiness
Seating Arrangement
Availability of Information about the practice
Availability of Health Information
Appearance of displays and noticeboards 

8. How do you rate our reception service

Please tick one option per row

Very Good Quite Good Neither Poor nor Good Quite Poor Very Poor
Politeness of receptionists
Helpfulness of receptionists
Appearance of receptionists
Appearance of reception area
How receptionists manage confidentiality
Queue time 

9. Do you feel that the reception service is always to the same standard (ie is it a consistent service?)

Please tick one option

Yes
No
Do not know

Waiting to be seen

10. When being called for your appointment which of the following would you prefer

Please tick one option

To be called in by the doctor
To be told which room to go by a receptionist
To be notified on screen of a room number to go to
No preference

11. How long do you normally wait in the waiting room to be called?

Please tick one option

Seen immediately
Seen within 5 - 10 minutes of appointment time
Seen within 10 - 20 minutes of appointment time
Seen within 20 - 30 minutes of appointment time
Seen more than 30 minutes after appointment time
Not aware

12. How do you rate the time you have to wait?

Please tick one option

Very Good
Quite Good
Neither Poor nor Good
Quite Poor
Very Poor

13. If you have to wait for your appointment to begin beyond the appointed time are you normally informed of the approximate waiting time?

Please tick one option

Always
Sometimes
Occasionally
Never

Health Centre Facilities

14. Do you consider that the Health Centre has adequate facilities for disabled people?

Please tick one option

Yes
No (If no please provide details below)
Not sure

15. Patient Toilets

Please tick one option per row

Very Good Quite Good Neither Poor nor Good Quite Poor Very Poor
How clean do you consider them to be?
How well equipped do you consider them to be?

In General

16. In a year how many times do you:

Please tick one option per row

1 or less 2-5 More than 5
Make an appointment?
Phone the surgery?
Attend the surgery ? (for an appointment or otherwise)

Patient Participation Group

17. Would you be interested in attending the Surrey Docks Patient Participation Group

(Please note we will not share your email address with anyone else, we will use your email address for the purposes of sending you information only)

Please tick one option

Yes, please send me more information my email address is:
No but I would like to be kept informed by email. (Please provide email address in the box below)
No thanks not at this time

18. Practice Name

In 2011 we took on a new partner and therefore the practice name is currently Drs Holden, Marrinan, O'Connor, Baxter and Dhir which is very long and we would like to find a new name which is easier for patients. Surrey Docks Health Centre is the name of the building that we share with another practice and with the dentist so we would like to find our own name, meaningful to us and our patients.

To help you with suggestions, we are a GP partnership, based in Surrey Docks. We provide NHS primary care services.


Ideas and suggestions for a new practice name:


19. If you have any other comments ideas suggestions about your experience of the practice, please let us know.