Friends and family test

The Friends and Family test was introduced in April 2015 as national measure of patient satisfaction for all providers of NHS care in England. It allows us to see what patients think of the care they receive when visiting hospital and it allows us to understand how we can improve the quality of the services we provide.

The test is anonymous. 

Please fill in the form below and tell us how we are doing. 

Date you were seen *

(DD/MM/YY)

Time of day *

AM

PM

Nature of visit * - Select -Clinical visitFor day care surgeryAccident and EmergencyFor pre-assessmentOther

Location * - Select -Barking ClinicBedford ClinicBedford Day UnitBattersea ClinicCity Road - Accident and EmergencyCity Road - Clinic 1City Road - Clinic 2City Road - Clinic 4City Road - Clinic 5City Road - Clinic 11City Road - Clinic 12City Road - Clinic 15City Road - Pre-Assessment ClinicCroydon ClinicCroydon Day Care UnitEaling ClinicEaling Day UnitLoxford ClinicMackellar Day Care Unit (Male)Mile End ClinicMile End Day Care UnitNorthwick Park ClinicNorthwick Park Day UnitPotters Bar ClinicPotters Bar Day UnitQueen Mary's ClinicRoehampton ClinicSedgwick Day Care Unit (Female)St Ann's ClinicSt. Anne's Day UnitSt. George's Day UnitTeddington Clinic

Service * - Select -AdnexalCataractContact Lens ClinicDay SurgeryECLOExternal Disease ClinicGlaucomaMedical Retina / UveitisNeurology / StrabismusPre-Operative AsessmentPrimary Care ClinicVitreo RetinaOther

How likely are you to recommend our service to friends and family if they need similar treatment? * - Select -Extremely likelyLikelyNeither likely or unlikelyUnlikelyExtremely unlikelyDon't know

Can you tell us why you gave this response?

Can we publish the above comment?

Yes

No

What is your age? - None -18-2425-2930-3950-5960-6970 plus

Gender? - None -MaleFemaleTransgenderOtherPrefer not to say

What is your ethnic group? - None -Asian / Asian BritishBlack / African/ Caribbean / Black BritishMixed / Multiple ethnic groupsOther ethnic groupWhite

Do you have a disability? - None -YesNoPrefer not to say

What code is in the image? * Enter the characters shown in the image.