Out of Hours Service - Satisfaction Questionnaire

You recently requested medical help or advice when your doctor's surgery was closed. Please answer the following questions about your experiences. If you have used the service more than once recently, please tell us about your most recent experience.

About the patient:
If you requested medical help for yourself, please give your own details. If you were seeking help for someone else, such as your child, please give details of that other person
1. The age of the patient (in years):
2. Is the patient
3. Please give the patient's postcode:

About the service you received

When you telephoned the out-of-hours service, did you:-
4. Receive advice over the telephone?
5. Which surgery or medical centre did you travel to?
6. Receive a visit in your home?
7. Were you happy with the way your call was handled?

If you did not attend the health centre please go to question 17
8. In your opinion, how clean was the Health Centre?
9. If visited, how clean were the toilets?
10. When you arrived, how would you rate the courtesy of the receptionist?
11. Did the clinician explain the reasons for any treatment or action in a way that you could understand?
12. Were you given enough time to discuss your health or medical problem with the clinician?
13. If you had questions to ask the clinician, did you get answers that you could understand?
14. Did the clinician treat you with respect and dignity?
15. Was the location of the Health Centre convenient for you to travel to?
16. If travelling by car were you able to park conveniently?

How satisfied are you with the following:
17. Getting through on the telephone?
18. The way your initial phone call was handled?
19. The time you had to wait before you finally saw or spoke to a doctor or a nurse?
20. The manner of the doctor or nurse?
21. The explanation the doctor or nurse gave you about your problem
22. The treatment or advice you were given
23. Overall, how satisfied were you with the service you received?
We are requested to ask Questions 24-27 by our commissioning PCT to ensure the service is accessible to all patients. Please note that you can select prefer not to say
24. What is the patient's ethnic origin?
If the patient's ethnic origin is "Other Ethnic Background", please specify:
25. Does the patient have a disability defined as a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry our normal day to day activities?
26. What are the patient's religious beliefs?
If the patient's religious beliefs are "Other Religion", please specify:
27. What is the patient's Sexual Orientation?
28. Do you have any additional comments or suggestions about the way the service could be improved?
dummy