Outpatient FFT Survey

English

Outpatient FFT Survey

Putting our patients first and ensuring we improve the quality of care is our main priority, this means listening and acting on your concerns. Please help us to improve our services by completing this short survey questionnaire about your experience of our services, it is free and will only take a few minutes of your time. Thank you.

Please choose the service you visited:

1. Thinking about your recent experience with us, overall, how was your experience of our service?

Very good Good Neither good nor poor Poor Very poor Don't know

Notes

2. Please tell us what was good about your care?

4000 characters remaining

Can we share your comment publicly (for example, on our website or printed material such as posters)?

Yes No

Notes

3. Please tell us what could have been improved?

4000 characters remaining

Notes

4. Overall how clean was the location or environment you were in?

Very good Good Neither good nor poor Poor Very poor Don't know

Notes

A little about you;

5. Which of the following options best describes how you identify yourself:

Male Female Non-binary Trans Man Trans Woman Other Prefer not to say

Notes

6. In which age group are you?

Under 18 18 - 25 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85 +

Notes

7. What do you consider to be your ethnic background?

White Mixed or multiple ethnic groups Asian or Asian British Black, Black British, Caribbean or African Other ethnic group Prefer not to say

Notes

8. Do you have any of the following conditions? (please tick all that apply)

A long standing physical condition A mental health condition A learning disability A long standing illness (e.g. asthma, diabetes, COPD, cancer, dementia, heart disease) Blind or partially sighted Deafness or severe hearing impairment Other None of the above

Notes