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 and enter you into our free prize draw 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 *

Your details will not be passed on to any third party and will only be used to keep you informed about One Medical and any developments that we think you may be interested in.

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.

Prize Draw open to all UK residents aged 18 and over with the exception of employees of One Medical, their immediate families, agents or anyone else associated with the administration of this promotion.

One winner will win a Hotel Chocolat hamper worth approx £100.

The winner will be drawn at random, in the presence of an independent person, from all surveys completed by the closing date.

The winner must agree to their photo and name being used in any post draw publicity.

No cash alternative will be offered.

THE CLOSING DATE FOR COMPLETED SURVEYS IS 01 FEBRUARY 2008

The winner will be notified by letter/telephone no later than 28 days from the closing date of the prize draw.

Entries from third parties or agents are invalid.

In the event of unforeseen circumstances, the promoter reserves the right to offer an alternative prize of equal or greater value.

One entry per person.

For the name of the winner please send a stamped SAE to Hayley Sadgrove, Ptarmigan PR, Airedale House, 423 Kirkstall Road, Leeds, LS4 2EZ

Yes! I have read and agree to the Terms and Conditions. *