Do you think that your surgery will be suitable for you and your patients' needs in five years time? * Yes No

Does lack of space prevent you from offering additional services, over and above GP provision, to your patients? * Yes No

Are you looking to relocate or expand your surgery in the next 12 months? * Yes No

What are the biggest challenges facing you/your surgery currently?

• Managing budgets
• Lack of space
• Managing staff
• Lack of facilities
• Health and Safety/Disabled access
• Premises ownership issues

Are there any other premises issues you think you/your surgery will face in the future?

In regards to your PCT:

Is additional funding available? * Yes No

If YES:

Does this cover additional rental? Yes No

If NO:

Please give detail:

Thank you for taking the time to fill out this survey. We would like to send you the results when they become available - please fill in your contact details below to enable us to do so.

Your Name *

Job Title

Practice/Place of Work

Address

Town/City

Postcode/Zip Code

County/State

Country

Telephone Number *

Email Address *

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If you wish to receive periodic updates on our services and developments, please check one or both of the following boxes. Please remove the tick if you do not want to be contacted using either of these methods.

• Yes, please keep me updated regarding One Medical via email.
• I am happy for One Medical to contact me via phone or post.