Patient Feedback Questionnaire 

Licensed doctors are expected to seek feedback from colleagues and patients and review 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 write your name on this questionnaire. 
Please base your answers only on the consultation you have had. 
4) How good was your doctor at each of the following? 
5) Please decide how strongly you agree or disagree with the following statements by ticking one box: 
The next questions will provide the doctor with some basic information about who took part in the survey. If you are filling this in on behalf of a child or a patient with a disability, please provide details about the patient.