This short survey should only take 5-10 minutes of your time to complete. For more info please click here.

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1. Which of the following activities would you enjoy taking part in if they were available at Whitestone Surgery for young people? (Please tick all that apply)*

2. If Whitestone Surgery offered support groups and activities for young people, would you use them? *

Please explain:

3. Do you have any ideas for activities or support groups that Whitestone Surgery could offer for young people?*

Please explain:

4. How would you describe the support for young people at Whitestone surgery?*

How often do you socialise? *

6. If you wanted to socialise more often, what would encourage you to do this? (Please tick all that apply)*

7. How often do you feel you are able to communicate with people around you about your worries and stressors? (This may include school/college stress, friendships/family problems etc).*

8. Are you Male/Female?*

9. How old are you*

Would you be interested in getting involved? *


Parent/Guardian name and contact details (e-mail or phone number)

Parent/Guardian permission to be contacted*

Your voice matters to us and we would like your input to help us develop activities for young people. This short survey is anonymous and the information that you have provided will be used solely for this purpose. If you wish to be contacted for further information, fill in the contact details, please indicate you have the permission from your parent/guardian. You can withdraw your data at any time. For any further information or questions, please contact Whitestone Surgery on 024 7664 1911.

To view our privacy policy please click here.

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We value your feedback

Do you have any suggestions, ideas or concerns? Are you interested in coming along to find out more? Why not contact us or drop in at reception.