Peninsula Community Health

The Friends and Family Test

We would like you to tell us what you think about the service you have recently used.

Please enter the service name (you can also find this on the Friends and Family Test form you received.)

Items marked with a * must be filled.

How likely are you to recommend the service to friends and family if they needed similar care or treatment?

How Likely? *


Please can you tell us the main reason for the score you have given?


If you have an issue or concern you would like to discuss further, or require this information to be presented in a different format or language, please contact our Patient Advice & Liaison Service (PALS) on 03003 301444

The following information helps us to understand how different groups of people feel about their experiences using our service.


Gender (Please tick all boxes that apply)


Ethnic Group

Thank you for taking the time to tell us about your experience. Your feedback will be used to improve our service.