T09 Request for useful feedback — Blank form
2026 digital edition · Dr Naeem Aziz DGM FRCP · 1 min read
Print this blank worksheet and complete it privately. Responses are not collected by the website. Do not include identifiable patient information. This is a planning aid, not an official application form.
Blank reusable form
Read with chapter 14 and 16
Invite specific evidence rather than a general testimonial. The respondent should be free to describe uncertainty and areas for development.
Purpose and recipient
Explain why feedback is requested and the recipient's relationship to the work.
Activity and observation period
Specify what they observed or reviewed and when.
Questions about practice
Ask about concrete reasoning, communication, leadership or teaching relevant to the activity.
Strengths and examples
Invite examples rather than unsupported adjectives.
Development and limits
Ask what could improve and what the respondent cannot assess.
Use and confidentiality
Explain intended use and agree how the response may be shared.
Your response and follow-up
Record what you learned, changed and will review.