1. Please tell us the name of the service you’d like to review
2. How likely are you to recommend this organisation to friends and family if they needed similar care or treatment?
3. How do you rate your overall experience of this service?
4. Summary of your experience
A brief description of your experience
5. Tell us more about your experience here
Expand on your feedback here. Why was the experience a good / bad one?
6. Would you like to get information on how to make a complaint or what support services are locally available to you?
If you’d like us to contact you please leave a telephone number and/or email address below.
The following monitoring questions are optional and anonymous, although they help us to ensure we are hearing from a wide range of people from all communities in Solihull.
7. Where do you live?
(Chelmsley Wood/Dorridge..)
8. What is your sexual orientation?
9. What gender do you identify yourself as?
10. Which age group are you in?
11. Do you consider yourself to have a disability?
12. Please tell us your religion
13. What is your ethnicity?