Form

Bolton Community Practice

Friends and Family Test

* Required

Surgery *

Ladybridge Astley dale Littele Lever Market

1) We would like you to think about your recent experiences of our service. How likely are you to recommend our GP Practice to friends and family if they needed similar care or treatment? *

Extremely likely Unlikely Likely Extremely unlikely Neither likely nor unlikely Don't know

2) Why? Please comment (optional)

3) My age is: *

16-18 19-24 25-35 36-45 46-65 65+

4) I am *

Female Male

Thank you for taking time to complete this survey