Friends and Family Test Friends and Family Test Thinking about your GP Practice… Overall how is your experience of the surgery? Very good Good Neither good or poor Poor Very poor Don’t Know Other What is your sex? Male Female Do not want to disclose What age are you? 0-20 21-40 41-60 61-80 81+ How likely would you be to recommend us to friends or family? Highly recommend Recommend Maybe recommend Wouldn’t recommend Definitely would not recommend Don’t know Based on your recent appointment, is there anything positive or anyone in particular that you would like to tell us about? Based on your recent appointment, is there anything we could have done better? What ethnic group are you? White Mixed/Multiple ethnic groups Asian/Asian British Black/African/Caribbean/Black British Other Ethnic group Your views are important to us – if you think we are doing well we aim to continue, if you feel we need to improve we will work with our staff and our patient participation group to see how we can do this. Please note the following feedback is collected on an anonymous basis, any comments received will be discussed within the practice in order to inform service improvement. However, there may be occasions when the practice would like to publish comments it has received – if you DO NOT want your comments to be published please tick below. I DO NOT want my comments to be published I am completing this feedback as the Patient or as the patient’s Carer/Representative I am the patient I am the patient’s carer/representative If you are human, leave this field blank. Submit