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Patient FFT Diabetes Care For You 322126
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1.
Question 1.
We would like you to think about your experience of this service
Overall, how was your experience of our service?
Required
- Required.
Very good
Good
Neither good nor poor
Poor
Very poor
Don't know
2.
Question 2.
Thinking about the service we provide, please can you tell us why you gave your answer?
3.
Question 3.
Please tell us about anything that we could have done better
4.
Question 4.
Please put a tick in one of the boxes for each of the questions below
Yes
No
If you had to contact the hub, was your call answered promptly?
Yes
No
Were you offered a choice of where you could be seen?
Yes
No
Were you satisfied with how you call/query was dealt with?
Yes
No
5.
Question 5.
Please tick the response boxes for each of the questions based on your experience of the community Diabetes service
Very satisfied
Satisfied
Neutral
Dissatisfied
Very dissatisfied
How satisfied are you with your current treatment?
Very satisfied
Satisfied
Neutral
Dissatisfied
Very dissatisfied
How satisfied are you with your understanding of your Diabetes?
Very satisfied
Satisfied
Neutral
Dissatisfied
Very dissatisfied
How satisfied would you be to continue with your present form of treatment?
Very satisfied
Satisfied
Neutral
Dissatisfied
Very dissatisfied
6.
Question 6.
How convenient have you been finding your treatment to be recently?
Very convenient
Convenient
Neutral
Inconvenient
Very inconvenient
7.
Question 7.
How flexible have you been finding your treatment to be recently?
Very flexible
Flexible
Neutral
Inflexible
Very inflexible
8.
Question 8.
How confident are you in terms of managing your own Diabetes?
Very confident
Confident
Neutral
Unconfident
Very unconfident
9.
Question 9.
Have you been able to discuss your ideas and goals about the best way to manage your Diabetes?
Yes
Not sure
Not at all
10.
Question 10.
What age are you?
0-15
16-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
11.
Question 11.
Are you male or female
Male
Female
Prefer not to say
I think of myself as
I think of myself as:
This is required
12.
Question 12.
The person completing this form
The Patient
A carer
A family member
13.
Question 13.
Do you consider yourself to have a physical or mental health condition or disability?
Yes
No
14.
Question 14.
What is your ethnic group?
White
British
Irish
Other
Asian or Asian British
Indian
Pakistani
Chinese
Bangladeshi
Any other Asian background
Mixed
White and Black Caribbean
White and black African
White and Asian
Any other mixed background
Black or Black British
Caribbean
African
Any other black background
Other Ethnic Group
Any other Ethnic Group
I do not wish to disclose my ethnic origin
15.
Question 15.
10. Are you happy for your feedback to be published anonymously?
Yes
No
*
16.
Question 16.
Was this survey completed via
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Website Link
QR Code
Paper Card