Questionnaire Form

Questionnaire Form

If you are filling this in for someone else, please answer the following questions from the patient’s point of view.

First Impressions

How good was your doctor today at each of the following? (Please tick one box in each line)

Please decide how strongly you agree or disagree with the following statements by ticking one box in each line.

The next questions will provide the doctor with some basic information about who took part in the survey. If you are filling this in on behalf of a child or a patient with a disability, please provide details about the patient.

If you would like to be contacted about any of these points please include your name and address below. (not required):

The GMC is a charity registered in England and Wales (1089278) and Scotland (SCO37750)