Patient Survey

Licensed doctors are expected to seek feedback from colleagues, patients and reviews and act upon that feedback where appropriate.

The purpose of this exercise is to provide doctors with information about their work through the eyes of those they work with and treat, and is intended to help inform their further development.

Please do not provide your name in this questionnaire.

Please base your answers only on the consultation you have had today.

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

Please note: no patients will be identified when this information is given to the doctor.

1Patient Survey

2How good was your Doctor today at each of the following:

3Please decide how strongly you agree or disagree with the following statements by ticking ONE box


Privacy Protection

Information entered into practice survey forms is used only for the purposes of processing your Survey information and is stored and accessed securely by designated Practice staff.

Issues raised in comments may be discussed between relevant members of the Practice. The information is used for quality monitoring purposes, in line with the expectations of the patients submitting the feedback.

Any personal information transmitted via Practice Survey forms may be anonymised by the Practice when this is required to ensure compliance with General Data Protection Regulation.

This information is not shared with any external third party organisations.

This information is kept for as long as the site is active or it is deleted by a site administrator.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Your Neighbourhood Professionals. Just a Click Away!
Denmark Road Surgery, 3 Enmore Road, South Norwood, London, SE25 5NT
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Your Neighbourhood Professionals. Just a Click Away!
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