Take the Survey

To fully understand Patient requirements in Ashbourne, we are currently undertaking this short survey to help us provide the best we can to you. All information is kept in the strictest confidence. Fields marked * are required fields.

1) Are you currently registered at a practice in ashbourne?
Answer:	ChooseYes No
2) If you are registered, is it NHS or Private?
Answer:	Choose Yes No
3) Would you like to be able to have NHS treatment?
Answer:	Choose Yes No
4) Which of the following would you like included at a new practice in Ashbourne? (please tick your preferences
Choose:	touch screen check in child play area disabled access downstairs surgery emergency appointments breast feeding facilities baby changing area private consultation room late night opening Saturday morning opening Onsite parking dental hygienist
5) Would you consider walking to the surgery from a free town centre car park?
Answer:	Choose Yes No
6) Would you like access from a free local shuttle bus service?
Answer:	Choose Yes No
7) Would it be better to be by more local medical facilities?
Answer:	Choose Yes No
8) Would you like free oral cancer screening as part of routine checkups?
Answer:	Choose Yes No
9) Would you like smoking cessation services?
Answer:	Choose Yes No
10) Would you like to be contacted if we are successful in our bid for the tender to open a practice in ashbourne?
Answer:	Choose YesNo
If you would like to be contacted, please provide your name and telephone in the box provided below.
Name and Telephone :