League of Friends Your + Health Survey

1. Please indicate to what extent you personally think it is important that each of the following services should be provided by the Milford Medical Centre by selecting one answer for each row. *

	Very UNimportant	Quite UNimportant	Neither/nor	Quite important	Very important
Pharmacy	Pharmacy Very UNimportant	Pharmacy Quite UNimportant	Pharmacy Neither/nor	Pharmacy Quite important	Pharmacy Very important
Blood Tests Locally	Blood Tests Locally Very UNimportant	Blood Tests Locally Quite UNimportant	Blood Tests Locally Neither/nor	Blood Tests Locally Quite important	Blood Tests Locally Very important
Mental Health Clinics	Mental Health Clinics Very UNimportant	Mental Health Clinics Quite UNimportant	Mental Health Clinics Neither/nor	Mental Health Clinics Quite important	Mental Health Clinics Very important
Ear Clinics	Ear Clinics Very UNimportant	Ear Clinics Quite UNimportant	Ear Clinics Neither/nor	Ear Clinics Quite important	Ear Clinics Very important
Care Coordinators	Care Coordinators Very UNimportant	Care Coordinators Quite UNimportant	Care Coordinators Neither/nor	Care Coordinators Quite important	Care Coordinators Very important
Wound Clinics	Wound Clinics Very UNimportant	Wound Clinics Quite UNimportant	Wound Clinics Neither/nor	Wound Clinics Quite important	Wound Clinics Very important
Leg Ulcer Clinics	Leg Ulcer Clinics Very UNimportant	Leg Ulcer Clinics Quite UNimportant	Leg Ulcer Clinics Neither/nor	Leg Ulcer Clinics Quite important	Leg Ulcer Clinics Very important
Better Balance Classes	Better Balance Classes Very UNimportant	Better Balance Classes Quite UNimportant	Better Balance Classes Neither/nor	Better Balance Classes Quite important	Better Balance Classes Very important

2. What are YOUR HEALTH NEEDS not currently provided locally that you would ideally like to be added to health services provided by the Milford Medical Centre? If there are no additional services you would like added please type in 'None' or skip the question.

Choice 1
Choice 2
Choice 3

3. We would like to know about you so we can be sure we are receiving responses from a wide range of individuals, please help us by answering the following questions.

Are you *

Female
Male
Prefer not to say

4. Your age *

5. Do you consider yourself to have a disability? *

Please make sure you complete this survey by the 31st May 2022. Any surveys submitted after the 31st May unfortunately will not be counted.

Your information and responses to the survey will be anonymous as no personal information is available to us via the survey.

League of Friends Your + Health Survey

1. Please indicate to what extent you personally think it is important that each of the following services should be provided by the Milford Medical Centre by selecting one answer for each row. *

2. What are YOUR HEALTH NEEDS not currently provided locally that you would ideally like to be added to health services provided by the Milford Medical Centre? If there are no additional services you would like added please type in 'None' or skip the question.

3. We would like to know about you so we can be sure we are receiving responses from a wide range of individuals, please help us by answering the following questions.Are you *

4. Your age *

5. Do you consider yourself to have a disability? *

3. We would like to know about you so we can be sure we are receiving responses from a wide range of individuals, please help us by answering the following questions.

Are you *