The Quarter Jack Surgery

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Out of hours: 111
Address: Rodways Corner, Wimborne, Dorset, BH21 1AP

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Questionnaire – NHS Healthcheck

If you had a NHS Healthcheck at The Quarter Jack Surgery in the past year, and have not already completed a feedback form, please submit your answers below.

Questionnaire – NHS Healthcheck

Please state month and year of check:

Were you aware of the NHS Healthcheck programme before you were invited?

YES - I read about it in the press

YES - I know someone who has had a check

YES - Someone at the surgery told me about the programme

YES - Other

NO

Were you given advice on any lifestyle issues or referred to further services?

YES - smoking

YES - alcohol

YES - weight reduction

YES - exercise

YES - cholesterol reduction

NO

Did you have/were you advised to book a follow-up appointment at the surgery ie for further testing?

Yes

No

Did you need continuing treatment ie medication for high blood pressure?

Yes

No

Were you happy with the care you received at your appointment by the nurse?

Yes

No

Do you feel the appointment was worthwhile?

YES - identified risk area(s)

YES - followed advice given

YES - had further tests

YES - reassured me

NO

Do you have any feedback/comments that you would like us to consider?

If your comments need a reply, please give us your full name and contact details:

Finally, please could you tell us a little about yourself:

Age:

Gender:

Male

Female

Which ethnic group do you belong to?

White/White British

Black/Black British

Mixed

Chinese

Asian/Asian British

Other ethnic group

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Questionnaire – NHS Healthcheck
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