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


FFT - CDC
Date of your Outpatient appointment:
Which Outpatient Department did you attend?

Thinking about your recent visit...
1Thinking about your Outpatient Appointment, overall, how was your experience of our service?
Would you please tell us why you gave this answer:
Very goodGoodNeither good nor poorPoorVery poorDon't know
2Please tell us about anything we could have done to improve your experience:
3Would you like to thank someone for providing excellent care during your visit? If so, please give their name and job role and describe what the person(s) did that was excellent.
4Occasionally, we like to find out more about how people experience our services, including what went well and what we can do to improve. If you would be happy for someone to contact you about your experience of our services, please leave your name and contact details (phone or email address) in the space provided:

A little bit about your child:
5Is your child:
MaleFemaleI do not wish to disclose this information
6What age is your child?
0-56-1112-1516-18I do not wish to disclose this informationI do not wish to disclose this information
7Do you consider your child to have a disability?
Yes (please give details)NoI do not wish to disclose this information
8What is your child’s ethnic group?
WhiteMixed/ multiple ethnic groupsBlack/ African/ Caribbean/ Black BritishAsian/ Asian BritishOther ethnic groupI do not wish to disclose this information

Complete Survey