Patient Feedback Survey

a friendly smile at reception

    Whitestone Surgery is committed to continually improving the experience for our service users. As part of this, we are keen to learn about the service you received today and would be grateful if you could fill in this short survey.

    On a scale of 1 to 5, 1 being very dissatisfied and 5 extremely satisfied, please could you give your ratings below:

    1. How satisfied were you with the process of booking your appointment for today?
    54321

    2. How satisfied were you with the waiting times at today’s appointment?
    54321

    3. How satisfied were you with the quality and outcome of today’s appointment?
    54321

    Your Name (optional)

    Your Email (optional)

    Your Phone/Mobile (optional)

    I would like to receive future updates from the surgery

    YesNo

    If you are interested in volunteering with local

    community groups,
    please tick here:

    You can also rate and review our performance on Google or the NHS website. Should you wish to update your contact details, book an appointment, request repeat medication or view your medical records, please click here.

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    Please note:

    This form is sent to Whitestone Surgery via e-mail. Please do not use this form to submit clinical Information, or to request or book appointments. Our practice policies and up-to-date information leaflets are on display in reception. For more information regarding our suggestions and complaints procedure click here. To view our privacy policy, please click here.