Crofton & Sharlston Medical Practice

Teenage Access Questionnaire

We are trying to make our services easier for young people to access and would appreciate it if you could take the time to complete and return this questionnaire please? All answers are confidential.

Teenage Access Questionnaire
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What gender are you? *
Would you find an area with information especially for young people on our practice website useful? *
If yes, what kind of information would you find helpful? Please select all that apply *
How would you prefer to get information about your health? *
Are you aware that you can attend an appointment at the surgery on your own (without an adult)? *
If you could have a telephone appointment with a GP or Nurse to discuss any health problem or concern – would you use this service? *
What time would be best for telephone appointments? *

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.