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Graham Road Surgery - Patient Survey

Where do you currently access GP medical services?
Graham Road Surgery
Horizon Health Centre
Other
In the event that Graham Road Surgery were to re-locate, would you be able to satisfactorily access the medical services at the Rugby Club site?
Yes
No
If the answer to Question 2 is No, what would you find most difficult about accessing services at the Rugby Club site?
If you access GP services from Graham Road Surgery, what transport method do you use to get to the practice?
Walk
Cycle
Drive / Driven
Public Transport
Community Transport (e.g. Dial-a-ride)
Other
Have you any views, suggestions or concerns about the relocation of primary care services to the new development that you would like to share with the team?
Equality Monitoring Questions:
Please provide us with some information about yourself. We do this to make sure that our services are being accessed by everyone who is entitled to use them. It is not compulsory to do so, but you can be assured that all the information you do provide will be kept completely confidential. No identifiable information about you will
be passed on to any other bodies, members of the public or press.
 
Equality Monitoring Questions:
Please provide us with some information about yourself. We do this to make sure that our services are being accessed by everyone who is entitled to use them. It is not compulsory to do so, but you can be assured that all the information you do provide will be kept completely confidential. No identifiable information about you will
be passed on to any other bodies, members of the public or press.
 
Are you...
Male
Female
Transgender
I would rather not say
Other
Please Specify:
Which age group applies to you?
16-24 years
25-34 years
35-44 years
45-54 years
55-64 years
65 years and over
I would rather not say
What is your ethnic group?
This is about the ethnic group to which you feel you belong and not about citizenship or nationality. If you feel you belong to more than one ethnic group, please choose the one you feel you most belong to or choose the ‘Mixed/multiple ethnic background’ option.
What is your ethnic group?
This is about the ethnic group to which you feel you belong and not about citizenship or nationality. If you feel you belong to more than one ethnic group, please choose the one you feel you most belong to or choose the ‘Mixed/multiple ethnic background’ option.
White
English/Welsh/Scottish/Northern Irish/British
Irish
Gypsy or Irish Traveller
Any other white background
Asian or Asian British
Bangladeshi
Indian
Pakistani
Chinese
Any other Asian background
Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other mixed/multiple ethnic background
Black/African/Caribbean/Black British
Caribbean African
Any other Black/African/Caribbean background
Other ethnic group - please specify
Which of the following options best describes how you think of yourself?
Heterosexual or Straight
Gay or Lesbian
Bisexual
Person asked and does not know or is not sure
Not stated (person asked but declined to provide a response)
Not known (not recorded)
Other
Please Specify:
What is your religion or belief?
Are you a disabled person as defined by the Equality Act 2010?
Yes
No
I would rather not say
The Equality Act 2010 defines a disabled person as “someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day to day activities”.
The Equality Act 2010 defines a disabled person as “someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day to day activities”.
If yes, please tick all which apply
Long-term illness/health condition
Learning Disability
Mental Health Condition
Physical Impairment
Sensory Impairment
Other
Thank you for completing the questionnaire and Equality Monitoring questions. If you have any further queries please email [email protected]
Thank you for completing the questionnaire and Equality Monitoring questions. If you have any further queries please email [email protected]
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