Important - The Old Surgery

The Old Surgery

572 Green Lane, London, N8 0RP

Telephone: 0300 033 7867

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How we use your personal information

Posted on June 5th, 2018

How we use your personal information This Privacy Notice explains why the GP practice collects information about you and how […]

Posted on June 5th, 2018

How we use your personal information This Privacy Notice explains why the GP practice collects information about you and how […]

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Opening Times

Monday
08:30am to 06:30pm
Tuesday
08:30am to 06:30pm
Wednesday
08:30am to 06:30pm
Thursday
08:30am to 06:30pm
Friday
08:30am to 06:30pm
Saturday
CLOSED
Sunday
CLOSED

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Name*
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Date of Birth*
Address*
Phone*
Email*
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Name
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81196

Patient Participation Group

Name*
First Last
Date of Birth*
Address*
Telephone (home)
Telephone (mobile)
Email
Phone
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88028

Online Patient Registration Form

Title*
Surname*
First Names*
Previous Surname/s
Sex*
- Male
- Female
Town and Country of Birth*
Date of Birth*
DD slash MM slash YYYY
NHS Number
Current Address and Postcode*
Telephone*
Mobile*
Have you previously been registered with an NHS GP in UK?*
- Yes
- No
Name of Previous GP*
Address of Previous GP*
Your Previous Address
Your first UK address*
Date you first came to UK*
DD slash MM slash YYYY
Are you returning from the Armed Forces?*
- Yes
- No
Please indicate if you have ever served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas*
- Regular
- Reservist
- Family Member
Address and Postcode before enlisting*
Service or Personnel Number*
Enlistment date*
Would you like to join the NHS Organ Donor Register?*
- Yes
- No
- Already on it
I want to register my details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after my death.*
- Any of my organs and tissue
- Kidneys
- Heart
- Liver
- Corneas
- Lungs
- Pancreas
Would you like to join the NHS Blood Donor Register?*
- Yes
- No
- Already on it
Tick here if you have given blood in the last 3 years
- I have given blood in the last 3 years
My preferred address for donation is:
Comments
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58433

Patient Survey

1Past Experience

2About the Practice

3The Clinicians

In the past 6 months, how easy have you found the following:*
Very easy Fairly easy Not very easy Very difficult N/A
Getting through on the phone
Speaking to a doctor on the phone
Speaking to a nurse on the phone
Obtaining test results by phone
Think about the last time you tried to see a doctor fairly quickly. Were you able to see a doctor on the same day or in the next two weekdays that the surgery was open?*
Yes No Cant remember
If you weren't able to be seen during the next 2 weekdays, why was that?
- There weren't any appointments
- Times offered didn't suit
- Appointment was with a Dr who I didn't want to see
- Only a nurse was free but I wanted to see a Dr
- Other
Please let us know the reason:*

How clean do you find the GP Surgery?*
Very clean Fairly clean Not very clean Not at all clean
How helpful do you find the receptionists?*
Very Fairly Not very Not at all
How long after your appointment time do you normally wait to be seen (excluding drop-in clinics)?*
I am normally seen on time 0-15 minutes 15-30 minutes More than 30 minutes Cant remember
How satisfied are you with the opening hours at the surgery?*
Very Fairly Neither satisfied nor dissatisfied Quite dissatisfied Very dissatisfied

How easy is it for you to get an appointment with a GP?*
Very easy Fairly easy Not very easy Not at all easy Don't know

The last time you saw a GP, how good was the GP at each of the following:*

	Very good	Good	Average	Poor	Very poor
Giving you enough time
Asking about your symptoms
Listening to you
Explaining tests & treatment
Involving you in decisions about your care
Treating you with care and concern
Taking your problems seriously

How easy is it for you to get an appointment with a Nurse?*
Very easy Fairly easy Not very easy Not at all easy Don't know

The last time you saw a Nurse, how good was the Nurse at each of the following:*

	Very good	Good	Average	Poor	Very poor
Giving you enough time
Asking about your symptoms
Listening to you
Explaining tests & treatment
Involving you in decisions about your care
Treating you with care and concern
Taking your problems seriously

Comments
This field is for validation purposes and should be left unchanged.

73025

Friends and Family Test

We would like you to think about your recent experiences of our service.
Thinking about your recent visit, overall, how was your experience of our service?*
- Very good
- Good
- Neither good nor poor
- Poor
- Very poor
- Don't know
Please can you tell us why you gave your answer?
Comments
This field is for validation purposes and should be left unchanged.

84717

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	Very easy	Fairly easy	Not very easy	Very difficult	N/A
Getting through on the phone
Speaking to a doctor on the phone
Speaking to a nurse on the phone
Obtaining test results by phone