Patient Satisfaction Questionnaire

Central Notts Clinical Services
Patient Satisfaction Questionnaire 

1. CNCS adopt the following Values. Please score from 1 to 6 (1 being the lowest, 6 being the highest), how well you felt CNCS achieved these Values;

Values	Score ( Not achieved 1 - 6 Fully achieved )
Committed; Our staff are professional and commmitted to the success of the organisation.	1 2 3 4 5 6
Approachable; We are here for you when you need us most.	1 2 3 4 5 6
Respectful; You can depend on our team to listen, without judgement or prejudice.	1 2 3 4 5 6
Exceptional; We aim to provide exceptional quality of care for you... our community.	1 2 3 4 5 6

2. Are you;

The Patient	Relative	Carer

3. Where were you treated?

Byron House (Out of Hours)	Newark (Out of Hours)	Leicester (Out of Hours)	Kirky Community Primary Care Centre (GP Surgery)	Walk in Centre (0800 - 2000)

4.Thinking of times you have phoned;

Was your call answered promptly? Was the person who answered your call polite and helpful?	Yes No Not Applicable
How would you rate the ability to speak to a Doctor or Nurse on the phone when you have contacted us needing medical advice?	Very Poor Poor Fair Good Very Good Excellent Does not apply

5. Thinking of times you have attended an appointment;

How do you rate the way you are treated by the receptionist on your arrival?	Very Poor Poor Fair Good Very Good Excellent Does not apply
How long did you have to wait for your consultation to begin?	5 minutes or less 6-10 minutes 11-20 minutes 21-30 minutes More than 30 minutes

6. Thinking about your last consultation, how do you rate the following;

	Very Poor	Poor	Fair	Good	Very Good	Excellent	Does not apply
How thoroughly the clinician asked about your symptoms and how you are feeling?
How well the clinician listened to what you had to say?
How well the clinician put you at ease during your physical examination?
How much the clinician involved you in decisions about your care?
How well the clinician explained your problems or any treatment that you need?
The amount of time the clinician spent with you?

7. After seeing the clinician, did you feel;

	Much more than before visit	A little more than before visit	The same or less than before visit	Does not apply
Able to understand your problem(s) or illness?
Able to cope with your problem(s) or illness?

8. All things considered;

	Completely satisfied	Very satisifed	Fairly satisfied	Neutral	Fairly dissatisfied	Very dissatisfied	Completely dissatisfied
How satisfied are you with the service you recieved?

Your views are very important to us and we welcome your feedback, therefore please add any further comments you wish to make or any suggestions for improvement:

Should you require a response to your comments, please leave your name and contact details and we will endeavour to respond to you as soon as possible. Alternatively, we may wish to contact you to discuss some of the comments that you have made. If you do not give us permission to contact you, please tick the following box;

I do not wish to be contacted

Name;
Address;
Telephone number;
Email;

Thank you for taking the time to complete this questionnaire.