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Patient FFT Diabetes Care For You 322126

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.

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

If you had to contact the hub, was your call answered promptly?
Were you offered a choice of where you could be seen?
Were you satisfied with how you call/query was dealt with?
Question 5.

Please tick the response boxes for each of the questions based on your experience of the community Diabetes service

How satisfied are you with your current treatment?
How satisfied are you with your understanding of your Diabetes?
How satisfied would you be to continue with your present form of treatment?
Question 6.

How convenient have you been finding your treatment to be recently?

Question 7.

How flexible have you been finding your treatment to be recently?

Question 8.

How confident are you in terms of managing your own Diabetes?

Question 9.

Have you been able to discuss your ideas and goals about the best way to manage your Diabetes?

Question 10.

What age are you?

Question 11.

Are you male or female

This is required
Question 12.

The person completing this form

Question 13.

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

Question 14.

What is your ethnic group?

White

Asian or Asian British

Mixed

Black or Black British

Other Ethnic Group

Question 15.

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

*
Question 16.

Was this survey completed via

- Required.