Purple Star Feedback Form
1.
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What is your name? (optional)
Please write your answer below. |
2.
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What is your telephone number? (optional)
Please write your answer below. |
3. If you are someone who supports this person, what is your name and contact details? (Optional)
4.
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What is the name and place of your doctors surgery?
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5.
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Do you think your doctors have a Purple Star?
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6.
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Have your doctors invited you for your annual health check?
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7.
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Did your doctor send you an annual health check preparation form when they invited you for your annual health check?
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8.
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Has your doctor sent you a Communication and Reasonable Adjustment form to fill in?
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9.
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At your appointments, does the nurse or doctor ask you if you have a purple folder?
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10.
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Were you given a Stay Healthy at Home Checklist by your doctor?
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11.
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Can you tell us what you think your doctors surgery does well?
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12.
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Can you tell us what you think your doctors surgery could do better? |