THE NHS FRIENDS AND FAMILY TEST We would like you to think about your recent experience of our service. How likely are you to recommend our Practice to friends and family if they needed similar care or treatment? Extremely Likely Likely Neither Unlikely Extremely Unlikely Don't Know Answer Thinking about your response to this question, what is the main reason why you feel this way? A little bit about you: Are you? Male Female N/A What Age are you? 0-15 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Do you consider yourself to have a disability? Yes No Which of the following best describes your ethnic background? Please Select White - British White - Irish White - Other Asian/Asian British - Indian Asian/Asian British - Pakistani Asian/Asian British - Bangladeshi Asian/Asian British - Chinese Asian/Asian British - Other Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Other Black/Black British - Caribbean Black/Black British - African Black/Black British - Other Other - Anything Else Other - I would rather not say Are you: The Patient Parent or Carer The Patient and Parent/Carer Thank you for completing the card and providing us with feedback to improve our services.If you DO NOT wish your anonymous comments to be shared then please tick here: Submit Should be Empty:
