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

 

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

 

3. Please tell us about anything that we could have done better

 

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

Strongly agreeAgreeNeither agree nor disagreeDisagreeStrongly disagree
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 information about your care and treatment?
Were you treated with kindness and compassion by the staff looking after you?
 

5. What age are you?

 

6. Are you male or female

 

7. The person completing this form

 

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

 

9. What is your ethnic group?

  • White
  • Asian or Asian British
  • Mixed
  • Black or Black British
  • Other Ethnic Group
 

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