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

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FFT Paramedic Emergency Service Survey
Date of survey
Which area do you live in?
Post Code
Were you taken to hospital?
Please tell us which hospital attended

Thinking about the service we provide...
1Overall, how was your experience of our service?
Very goodGoodNeither good nor poorPoorVery poorDon’t know

Additional commentary feedback
2Can you please tell us why you chose your answer above?
3Please tell us about anything that we could have done better:

Information about the patient
4What is your gender?
MaleFemalePrefer not to say
5What is your age?
Under 1616 - 2425 - 3435 - 4445 - 5455 - 6465 - 7475 - 8485+
6What is your ethnic group?
WhiteAsian / Asian BritishBlack / African / Caribbean / Black BritishMixed /Multiple ethnic groupOther ethnic groupPrefer not to say
7If you consider yourself to have a disability, please indicate the type of disability below:
Hearing impairment
  Learning disability
Visual Impairment
  Mobility impairment
Mental health
  Dementia
Other
  Prefer not to say

Complete Survey