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Community Neurological Rehabilitation Team West Patient Feedback Survey 325993

Page 1

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Question 1.

We would like you to think about your experience of this service
Overall, how was your experience of our service?

- Required.
Question 2.

Thinking about the service we provide, please can you tell us why you gave your answer?

Question 3.

Please tell us about anything that we could have done better

Question 4.

How was your appointment held 
This is required
This is required
Question 5.

Please put a tick in one of the boxes for each of the questions below

Were you treated with dignity and respect?
Were you involved as much as you wanted to be in your care and treatment?
Did you receive timely information about your care and treatment?
Were you treated with kindness and compassion by the staff looking after you?
Question 6.

What age are you?

Question 7.

Are you male or female

This is required
Question 8.

The person completing this form

Question 9.

Do you consider yourself to have a physical or mental health condition or disability?

Question 10.

What is your ethnic group?

White

Asian or Asian British

Mixed

Black or Black British

Other Ethnic Group

Question 11.

10. Are you happy for your feedback to be published anonymously?

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Question 12.

Was this survey completed via

- Required.

Thank you for completing this survey.  If you would like to provide feedback for any future projects, please email us at

sc-tr.cnrtwest@nhs.net and provide your name, email address and/or telephone number so we can contact you.