The De Parys Group Appointment Feedback (Friends and Family Test)
1. Thinking about your recent appointment or consultation with us, overall, how was your experience of our service?
Very good
Good
Neither good nor poor
Poor
Very poor
Don't know
2. Thinking about your recent appointment with us, please can you tell us why you gave us the rating above?
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3. Thinking about your recent appointment with us, can you tell us what went well?
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4. Thinking about your recent appointment with us, please can you tell us about anything we could have improved and if possible suggest how?
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5. Was your appointment face to face or via telephone?
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Face to face
Via telephone
6. Which staff type was your appointment with?
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GP
Pharmacist
Practice nurse
Healthcare Assistant
Pharmacy Technician
Minor Illness Nurse
Not sure
Prefer not to say
7. Do you have any other comments?
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No
Yes
(7) Add your comments here
8. Please can you select from the dropdown list your age (if you are completing the survey yourself) or the age of the person for whom you are completing the survey.
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Please Select
0-4 years
5-9 years
10-14 years
15-19 years
20-24 years
25-29 years
30-34 years
35-39 years
40-44 years
45-49 years
50-54 years
55-59 years
60-64 years
65-69 years
70-74 years
75-79 years
80-84 years
85+ years
Prefer not to say
9. Please state your ethnicity
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Please Select
Asian, Asian British or Asian Welsh
Black, Black British, Black Welsh, Caribbean or African
Mixed or Multiple ethnic groups
White British
White other (e.g. White European)
Prefer not to say
Other ethnic group (please specify)
Please specify your ethnic group
Submit
Should be Empty: