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Stack Garth | Brandon | Durham | DH7 8SJ | telephone 0191 378 2099

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Feedback Matters

Please complete our New Friends and Family Questionnaire.

 

 

 

Friends and Family Questionnaire

Please complete the following details:

Date
What service have you used recently?
Doctor Nurse HCA
Other

We would like you to think about your recent experience of our service:
How likely are you to recommend our service to friends and family if they needed similar care or treatment?
Extremely Likely Likely Neither Likely nor Unlikely
Unlikely Extremely Unlikely Don't Know

Comment
   
If you are happy for the Practice to publish the above comment, please tick the box:  

Your Gender Male Female

Ethnicity
British Group Mixed/Multiple Ethnic Group Asian/Asian British
Other

Age Group
0 - 15 yrs 16 - 24 yrs 25 - 34 yrs
35 - 44 yrs 45 - 54 yrs 55 - 64 yrs
65 - 74 yrs 75 +  

Do you have limited mobility?
YES Limited a lot YES Limited a little NO
Prefer not to say