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About your surgery
Please complete all sections of the form and click 'Submit Feedback'.
How likely are you to recommend our GP practice to friends and family if they need similar care or treatment?
Neither likely or unlikely
Thinking about your response to this question, what is the main reason why you feel this way?
What age are you?
Do you consider yourself to have a disability?
If yes, please provide details:
Which of the following describes your ethnic background?
Other white background
Other Asian background
White and Black Caribbean
White and Black African
White and Asian
Other Mixed Background
Other black background
I would rather not say
The parent or carer
The patient and parent/carer
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