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Vocare South West are constantly striving to improve the quality of our service and we welcome your honest comments. Your comments and responses will remain anonymous.

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What is the patient's postcode?

Date

Which centre did you attend?

How likely are you to recommend our service to your friends and family if they need similar care? *
Extremely unlikely Unlikely Neither likely or unlikely Likely Extremely likely

Can you tell us why you gave that response?

Was the clinician's consultation with you: *
Poor Fair Good Very good Excellent

Was the clinician's understanding of why you were seeking help: *
Poor Fair Good Very good Excellent

Was the clinician's explanation of things and what to do next: *
Poor Fair Good Very good Excellent

Was the clinician's reassurance to you: *
Poor Fair Good Very good Excellent

Was the clinician's attitude toward you: *
Poor Fair Good Very good Excellent

Would you rate the consultation environment: *
Poor Fair Good Very good Excellent

Would you rate the privacy of the consultation room: *
Poor Fair Good Very good Excellent

Were your details dealt with in a confidential manner whilst attending the reception area: *
Poor Fair Good Very good Excellent

Is the patient: *
Male Female

What age is the patient? *

0-15

16-24

25-34

35-44

45-54

55-64

65-74

75-84

Over 85 years old

What is the patient's ethnic group? *

White

Mixed / Multiple ethnic groups

Asian / Asian British

Black / African / Caribbean / Black British

Other ethnic group

Are the patient's day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months? (include any issues / problems related to old age)

Yes, limited a lot

Yes, limited a little

Prefer not to say

Website

Is there anything else you would like to add about your experience with this service? (Up to 250 words)

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Bath & North East Somerset, Swindon and Wiltshire 111

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