Patient Survey Patient Survey Patient feedback survey What is your postcode? Postcode Are you a Patient or a Carer? Patient Carer Both Do you consider yourself to be disabled or have a long-term health condition ? Yes No If yes – please describe. Optional What is your Gender?MaleFemalePrefer no to sayWhat is your age bracketUnder 2525-5050-75over 75What is your ethnicity?Asian or Asian BritishAsian or Asian British IndianAsian or Asian British PakistaniAsian or Asian British BangladeshiAsian or Asian British ChineseAny other Asian backgroundBlack, Black British, Caribbean or AfricanCaribbeanAfricanAny other Black, Black British, or Caribbean backgroundMixed or multiple ethnic groupsWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed or multiple ethnic backgroundWhiteEnglish, Welsh, Scottish, Northern Irish or BritishIrishGypsy or Irish TravellerRomaAny other White backgroundOther ethnic groupArabAny other ethnic groupWhat comments do you have regarding the proposal for the entity change for the Bounces Road Surgery from Partnership to Limited Company Status?What do you like about The Bounces Road Surgery that you would like to see continue if the proposed change takes place?What do you think could be better or improved at The Bounces Road Surgery ?