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

Brandon Lane Surgery





Friends and Family Questionnaire

Please complete the following:
What services have you used recently?
If you used one of our other services, i.e. our Counsellor, please enter here:
We would like you to think about your recent experience of our services:
How likely are you to recommend our service to friends and family if they needed similar care or treatment?
Extremely LikleyLikelyNeither Likely nor UnlikelyUnlikelyExtremely UnlikelyDon't Know
If you are happy for the Practice to publish the above comment, please tick the box: I am happy for you to publish my commentI DO NOT wish to have my comment published
Your Gender
British GroupMixed/Multiple Ethnic GroupAsian/Asian British
If your ethnic group is not listed above, please enter it here:
Age Group
0-15 yrs16-24 yrs25-34 yrs35-44 yrs45-54 yrs55-64 yrs65-74 yrs75+
Do you have limited mobility?
YES Limited a lotYES Limited a littleNOPrefer not to say