Which service are you giving feedback about?

Please Select...

Which area/location or team is this?

Please Select...

Tell us

1.TB Service - Type of service:

Active TB patient

BCG

TB screening

1.Diabetes Nursing - Type of Diabetes:

Gestational

Type 1

Type 2

1.Urgent Treatment Centre - Following being triaged, who were you seen by?

iPlease only give feedback on this survey about your recent attendance at an urgent treatment centre, not an A&E department at a large hospital.

1.Sexual Health Service - Type of service:

1.MSK Physiotherapy - If you attended a group session, please select which one:

Thinking about the service we provide

1.Overall, how was your experience of our service?

2.What was good about your experience?

3.What would make your experience better?

Data we collect from the questions in this section helps us to improve how we support patients with communication and information needs relating to a disability, impairment or sensory loss. Your feedback will help us to develop staff training and make sure resources are available for people accessing our services.

4.(NOT USED) If you need help to communicate or understand information, did we support you (for example, provide an interpreter, Easy Read, large print etc)? Please tell us anything that will help us to understand your experience.

4.If you have any communication or information needs relating to a disability, or sensory loss, did the service support you with this?

5.Which of these activities support your needs (you can tick all that apply):

Information in an alternative format (for example, Braille, easy read or large print)

Contact via a specific method (for example, phone, text or email)

A communication professional (for example, a deafblind or British Sign Language interpreter)

Use of communication methods or communication aids and tools (for example, lipreading or a hearing aid)

A longer time slot for an appointment

Something else (please state in box)

To ensure that all members of our local communities are experiencing fair and satisfactory services, we would like to ask you to share some diversity information about yourself. You do not have to answer all the questions. If you do not feel comfortable sharing your details for any of the questions, you can select ‘I'd prefer not to say’ or leave unanswered. Any questions you choose to answer will not identify you.

5.Age:

6.(NOT USED) Gender identity:

6.Gender identity:

7.Sexual orientation:

8.(NOT USED) Ethnic group:

8.Ethnicity:

9.Religion/belief:

10.Do you have a health condition or disability which makes it difficult for you to do everyday things? (this could be mental or physical)

Yes

No

I'd prefer not to say

Data we collect from the questions in this section helps us to better understand the unique experiences of the British Armed Forces Community and ensure they receive the best care and support. This includes serving personnel, reservists, veterans or immediate family members.

11.Have you ever served in the British Armed Forces?

Yes

No

I'd prefer not to say

12.Has anyone in your immediate family (spouse, civil partner, parents and children) ever served in the British Armed Forces?

Yes

No

Don't know/Not sure

I'd prefer not to say

Please tick this box if you do not wish your comments to be made public

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