Patient Questionnaire

In our efforts to improve the services we offer, we would appreciate it if you would take the time to complete this short questionnaire.

General Medical Council Note

Licensed doctors are expected to seek feedback and review and act upon that feedback where appropriate.  The purpose of this exercise is to provide them with information about their work through the eyes of those they treat and is intended to help inform their further development.  Please base your answers only on the consultation you have recently had with Dr Naomi Whitelaw. Answers are submitted confidentially – your name is not required.
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Are you filling in this questionnaire for:
Which of the following best describes the reason you saw the doctor? (Please tick all the boxes that apply)
If you are filling this in for someone else, please answer the questions from the patient’s point of view.
On a scale of 1 to 5 (1 = not very, 5 = very) how important to your health and wellbeing was your reason for visiting the doctor?
How good was your doctor at being polite?
How good was your doctor at making you feel at ease?
How good was your doctor at listening to you?
How good was your doctor at assessing your medical condition?
How good was your doctor at explaining your condition and treatment?
How good was your doctor at involving you in decisions about your treatment?
How good was your doctor at providing/arranging treatment for you?
This doctor will keep information about me confidential
Please decide how strongly you agree or disagree with the statement by ticking one box only.
This doctor is honest and trustworthy
Please decide how strongly you agree or disagree with the statement by ticking one box only.
I am confident about this doctor’s ability to provide care
I would be completely happy to see this doctor again
Was this visit with your usual doctor?
Please note: Should you choose to include specific information or your name, please know that no patients will be identified when this information is given to the doctor.
Are you:
Age:
What is your ethnic group?
We strive to improve, so if there is anything we could have done differently or, that you think we could do to improve things, please let us know.