Oak Street, Norwich, NR3 3DL
01603

Patient Survey – 2016/17

Dear Patient,

In order to ensure that the services our practice provides suit the needs of our patients, we regularly perform a patient survey to gain information that will allow us to develop the practice in a way that reflects patients’ requirements. We would be very grateful to you for your help by taking a couple of minutes to answer this survey. The survey is completely anonymous, and the information gained will be used in the future planning and development of the practice.

Yours faithfully,

Dr Christopher Dent (Senior Partner)

Bill Albert (Chair of the Oak Street patient Participation Group)

Please complete the survey and return in the envelope provided

Oak Street Medical Practice – Patient Survey 2016/17

About You / Yes / No
Age
Gender / Male / Female
Ethnic group – please state what you consider to be your ethnicity
Are you a carer? / ☐ / ☐ /
If so, would you be prepared to have this information on your medical record? / ☐ / ☐ /
Does someone care for you? / ☐ / ☐ /
If so, would you be prepared to have this information on your medical record? / ☐ / ☐ /
Do you have a long-term medical condition for which you see the doctor or nurse on a regular basis? / ☐ / ☐ /
Services at Oak Street Medical Practice
Many organisations, services and clinics are based at Oak Street Medical Practice. Which of the following organisations, services or clinics are you aware of? (Tick all options that apply)
  • Patient Participation Group
/ ☐ /
  • Coffee mornings for patients and carers
/ ☐ /
  • Physiotherapy Clinics
/ ☐ /
  • Community Midwife Clinics
/ ☐ /
  • Substance Misuse Support Clinics
/ ☐ /
  • Wellbeing Clinic (Mental Health Treatment & Support)
/ ☐ /
  • Sexual Health Advice (Contraception, STIs)
/ ☐ /
  • Health Checks & Lifestyle Advice (Diet, Exercise, Smoking Cessation, Weight Loss)
/ ☐ /
  • Asthma, Diabetes, COPD (smoking related lung disease), Blood Pressure, & Heart Disease Clinics
/ ☐ /
  • Warfarin Monitoring Clinics
/ ☐ /
  • Blood Tests
/ ☐ /
  • Vasectomy Service
/ ☐ /
Services you would like to see offered at Oak Street Medical Practice
Which, if any, of the following services would you like to see at Oak Street Medical Practice? (Tick all options that apply)
  • Exercise Classes such as Yoga, Pilates, and Relaxation Classes
/ ☐ /
  • Patient Mutual Support Groups (for instance – Bereavement Support Groups, Dementia Support Groups
/ ☐ /
  • Coffee Mornings for patients and/or their carers with long term medical conditions
/ ☐ /
  • “Art/Music as Therapy” Groups
/ ☐ /
  • Age UK Clinics
/ ☐ /
  • Social Worker Clinics
/ ☐ /
  • Equal Lives
/ ☐ /
  • None of the above
/ ☐ /
  • Other – Please state in the space below
/ ☐ /
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Regarding the suggestions above:- / Yes / No
  • Would you be interested in attending any of these groups if they were available?
/ ☐ / ☐ /
  • Would you be interested in supporting or running such a group?
/ ☐ / ☐ /
  • Would you be willing to make a modest financial contribution to fund these non-NHS Services?
/ ☐ / ☐ /
If the answer to any of the above is yes – please let us know your details separately so that we can assess the level of support and potential for development of such groups.
Communication from your Practice
How would you prefer to be contacted by, or receive information from, the Practice? (Regarding appointments, reminders for blood tests or medical reviews etc. – Tick all options that apply)
  • Letter
/ ☐ /
  • Telephone Call
/ ☐ /
  • E-mail
/ ☐ /
  • Text Message
/ ☐ /
  • Facebook
/ ☐ /
  • Twitter
/ ☐ /
  • None of the above
/ ☐ /
  • Other – Please state in the space below
/ ☐ /
......
......
Communication to your Practice
What methods would you prefer to be able to use to contact or provide information to the Practice? (Tick all options that apply)
  • Letter
/ ☐ /
  • Telephone Call
/ ☐ /
  • E-mail
/ ☐ /
  • Text Message
/ ☐ /
  • Online services on Practice Website
/ ☐ /
  • None of the above
/ ☐ /
  • Other – Please state in the space below
/ ☐ /
......
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Please make any other comments regarding your views of the practice or the service we provide.
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Thank you for your time and views.

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