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IQVIA Connection Desktop - Complete Questionnaire
Please complete the form below. Please use the text boxes provided to add any comments.


CYPS Eating Disorders
Service
Date

Thinking about your recent visit...
1Overall, how was your experience of our service?
Very goodGoodNeither good nor poorPoorVery poorDon’t know
2Please can you tell us why you gave this response?

Your Views Matter - Tell us about your care and the service provided
3When was the last time you saw someone from our services?
In the last month1-3 months4-6 months7-12 months12 monthsDon’t knowNever
4Do you feel you were treated with dignity and respect? Please add a comment if you would like to explain your answer further
AlwaysOftenRarelyNever
5Were you given (or offered) a copy of your care plan?
Yes, in the last yearYes, more than a year agoNoNot sure
6Have you been involved in planning your care? Please add a comment if you would like to explain your answer further
Yes, completelyYes, to some extentNo
7Can you contact a member of the team? Please add a comment if you would like to explain your answer further
YesNoDon't know
8How well does the Eating Disorder Service organise the care and services you need? Please add a comment if you would like to explain your answer further
Very wellWellNot very well
9Did you experience any problems with the quality of care you received that were not resolved? Please add a comment if you would like to explain your answer further
No problems experiencedYes, there was a problem, but it was resolvedYes, there was a problem which was unresolved
10Do you have a Crisis Plan?
YesNoDon't Know / Can't Remember
11Do you feel you have been involved in the development of your Crisis Plan?
Yes, fully involvedYes, partially involvedNo – not involvedDon't know/Can't remember
12In the event of needing to use the Crisis Plan, how confident are you that it will help/be useful?
Very ConfidentSomewhat ConfidentNot Confident at allDon't know / Don't wish to answer

Medication
13Was any medication (e.g. tablets, injections, liquid medicines, etc) prescribed for you during your treatment by the team?
YesNoI don't know / don't wish to answer
14Do you think your views were taken into account in deciding which medication to take?
Yes, definitelyYes, to some extentNoI don't know / don't wish to answer
15Were the purposes of the medication explained to you (verbally and in the form of information leaflets)?
Yes, definitelyYes, to some extentNoI don't know / don't wish to answer
16Were the purposes of the medication explained to you (verbally and in the form of information leaflets)?
Yes, definitelyYes, to some extentNoI don't know / don't wish to answer
17Were you told about possible side effects of the medication (either verbally or in writing)? Please add a comment if you would like to explain your answer further
Yes, definitelyYes, to some extentNoI don't know / don't wish to answer
18Has a member of staff checked the benefits and side effects of your medication with you (i.e. have your medicines been reviewed?) Please add a comment if you would like to explain your answer further
Yes, definitelyYes, to some extentNoI don't know / don't wish to answer

Information about your care
19Were you given information about your care in a way that you were able to understand?
YesNo

Your overall experience
20How would you rate your experience of service overall? On a scale of 0 – 10 (0- Not at all satisfied and 10 – Extremely satisfied)
10 - Extremely satisfied9876543210 - Not at all satisfied

Comments
21Please feel free to add any additional comments or suggestions for improvement in the space below:

Complete Survey