Family Planning Service

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You have been sent this questionnaire because you have had a family planning appointment at Northgate Medical Practice.

Yourfeedback is extremely valuable and would be greatly appreciated.

Your comments will help us to continue to develop and improve services, so please try to complete this as fully as possible. This questionnaire will remain anonymous and your subsequent treatments will not be affected by your response.

Type of procedure
Waiting Time
Appointment Experience
Age Group

It would help us to ensure that we have collected the views of all our patients, if you could provide us with the following information:

Thank you for taking the time to complete this questionnaire about your family planning appointment.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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