AJM Healthcare - Service user satisfaction survey

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1. Service user satisfaction feedback survey
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The NHS Wheelchair Service is committed to improving the service that we provide. To do this, we need your feedback. 

This is a secure website.  AJM Healthcare will not disclose any of your information to any third party. 

AJM will treat all the information provided in the strictest of confidence. 

* These questions require a response, please type N/A if you do not wish to provide this information.

We thank you for taking the time to complete the survey.
 

1. In which CCG (Clinical Commissioning Group) area do you live?

 

2. What was the service user's age bracket at the time of the appointment (choose one)? *

 

3. Who are you (choose one)? *

 

4. What was the date of your appointment? *

   DD/MM/YYYY 
 
 

5. What is the staff ID code or the name of the AJM therapist, engineer or technician who saw you?

 

6. What was the reason for your appointment (choose the one which fits best)? *

 

7. Overall, how was your experience of our service? *

 

8. General questions *

Very satisfiedSatisfiedNeither satisfied nor dissatisfiedDissatisfiedVery dissatisfied
Did the wheelchair service treat you with dignity and respect
Were you seen at a convenient time?
Did they listen to you?
Did you understand what they told you?
 

9. Personal wheelchair budgets (PWB) have replaced the older 'voucher scheme'. Did we tell you about PWB? *

 

10. Clinical assessment (please check 'N/A' if not relevant to this visit) *

Very satisfiedSatisfiedNeither satisfied nor dissatisfiedDissatisfiedVery dissatisfiedN/A
Were you involved in making decisions about your care?
Did you get the care or service that you needed?
Were the needs of your carer or personal assistant met?
Were you happy with the time it took from referral to being seen?
Were you happy with the referral booking process?
How satisfied are you with the information that we provided to you?
 

11. Provision of equipment *

Very satisfiedSatisfiedNeither satisfied nor dissatisfiedDissatisfiedVery dissatisfiedN/A
Were you happy with the time it took from your assessment to receiving your wheelchair or other equipment?
How satisfied were you with the support and training given to you about the use of your wheelchair when it was provided?
Has the provision of equipment improved your posture?
Has your level of independence increased following provision of equipment?
 

12. Wheelchair repair and maintenance (please check 'N/A' if not relevant to this visit) *

Very satisfiedSatisfiedNeither satisfied nor dissatisfiedDissatisfiedVery dissatisfiedN/A
How satisfied were you with the quality of work completed?
 

13. What did the wheelchair service do well? *

 

14. How could we improve the service? *