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How likely are you to recommend our Practice to friends and family if they needed similar care or treatment?

Extremely likelyLikelyNeither likley or unlikleyUnlikleyExteemely unliklelyDon't know

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

Which service did you use and when did you use it?

The information below will help to make sure that we receive feedback from a representative sample of the patients registered at this practice.

Your Gender
MaleFemale

Your age
---Under 1617 – 2425 – 3435 – 4445 – 5455 – 6465 – 7475 – 84Over 84

Do you consider yourself to have a disability?
YesNo

Which of the following best describes your ethnic background?
---White BritishWhite IrishMixed (White & Black Caribbean)Mixed (White and Black African)Asian or Asian British (Indian)Asian or Asian British (Pakistani)Asian or Asian British (Bangladeshi)Black or Black British ( Caribbean)Black or Black British ( African)ChineseOtherI would rather not say

Are you?
the patientthe parent or carer