How likely are you to recommend our practice

Extremely LikelyLikelyNeither likely or unlikelyUnlikelyExtremely UnlikelyDon't Know


We would like you to think about your recent experience of our services. How likely are you to recommend our practice to friends and family if they needed similar care or treatment?

Thinking about your response to this question, what is the main reason why you feel this way?


A little bit about you:

Are you?

MaleFemale

What age are you?

0-1516-2425-3435-4445-5455-6465-7475-8485+

Do you consider yourself to have a disability?

YesNo

Details:


Which of the following best describes your ethnic background?
White
BritishIrishOther white background


Asian or Asian British
IndianPakistaniBangladeshiChineseOther Asian background


Mixed
White and Black CaribbeanWhite and Black AfricanWhite and AsianOther Mixed Background


Black or Black British
CaribbeanAfricanOther white background


Other
Anything elseI would rather not say


Are You?

The patientThe parent or carerThe patient and parent/carer