College Green Medical Practice
Friends and Family Test Form
Patient Details and Feedback
(Stage 1 of 2)
Full Name
Date of Birth (For example, 31 3 1980) (Optional)
Contact Number (Mobile) (Optional)
Email Address
How likely are you to recommend our GP practice to friends and family, if they needed similar care or treatment?
Extremely likely
Likely
Neither likely nor unlikely
Unlikely
Extremely unlikely
I consent to being contacted via the details given above. I agree to the
privacy policy.
Yes
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