Target lung health check face to face survey

1. What age category are you in?

55 - 60 years 61 - 65 years 66 - 70 years 71 - 75 years

2. Are you?

Male Female Gender neutral Other Prefer not to say

3. Ease of booking today’s appointment

Excellent Good Adequate Poor

4. Location of mobile unit

Excellent Good Adequate Poor

5. Process of getting your consent to participate in the health check

Excellent Good Adequate Poor

6. Information provided to you

Excellent Good Adequate Poor

7. Explanation of the checks and results process

Excellent Good Adequate Poor

8. Waiting time

Excellent Good Adequate Poor

9. Experience of having the scan (if applicable)

Excellent Good Adequate Poor

10. Communication from staff during health check

Excellent Good Adequate Poor

11. Facilities on board

Excellent Good Adequate Poor

12. Overall impression of the care received during health check

Excellent Good Adequate Poor

13. Please use the box below if you would like to make any further comments on any of the above

4000 characters remaining

14. Which of the following encouraged you to attend today? Please tick all that apply

Receiving an invitation to attend It will help find lung disease early It will lower my chances of dying from lung disease It will reduce my anxiety about lung disease It will help my family not worry as much It will give me peace of mind A friend or family member encouraged me to take part Other, please specify below

15. Please add your comments here

4000 characters remaining

16. If required, how willing are you to continue to take part in the Lung Health Check programme on a scale of 1 – 10 (where 1 is completely willing and 10 is not at all willing)?

1 - extremely likely 2 3 4 5 6 7 8 9 10 - extremely unlikely

17. Where would you usually get information regarding health issues? Please tick all that apply

My GP Internet Magazines/newspapers Friends/family Other

18. If you answered 'other' to question 17, please specify below:

4000 characters remaining

19. Roughly how many times have you seen your GP or a hospital doctor in the last year?

0 1 - 4 5 - 9 10+

20. Have you attended any medical screening in the past (e.g. mammography or bowel scope)?

Yes No

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

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

22. Please tell us how you travelled to your appointment?

Car/Taxi Walk Cycle Train Other

23. If you selected 'Other' to question 22, please specify below

4000 characters remaining

24. Approximately how many minutes did it take you to get here?

4000 characters remaining

This next section is optional, if you don't wish to answer the next few questions please end the survey here. Thank you for your time today

25. Do you consider yourself to have a physical disability/impairment?

Yes No Prefer not to say

26. What is your ethnicity?

27. Are you a carer?

Yes No Prefer not to say

Target lung health check patient survey

The purpose of this survey is to help us understand your experience of the Lung Health Check you received today and to better understand why you chose to attend. In turn we hope that your responses will allow us to improve the service and encourage more people to attend. This survey is anonymous.

1. What age category are you in?

2. Are you?

3. Ease of booking today’s appointment

4. Location of mobile unit

5. Process of getting your consent to participate in the health check

6. Information provided to you

7. Explanation of the checks and results process

8. Waiting time

9. Experience of having the scan (if applicable)

10. Communication from staff during health check

11. Facilities on board

12. Overall impression of the care received during health check

3. Ease of booking today’s appointment

4. Location of mobile unit

5. Process of getting your consent to participate in the health check

6. Information provided to you

7. Explanation of the checks and results process

8. Waiting time

9. Experience of having the scan (if applicable)

10. Communication from staff during health check

11. Facilities on board

12. Overall impression of the care received during health check

13. Please use the box below if you would like to make any further comments on any of the above

14. Which of the following encouraged you to attend today? Please tick all that apply

15. Please add your comments here

16. If required, how willing are you to continue to take part in the Lung Health Check programme on a scale of 1 – 10 (where 1 is completely willing and 10 is not at all willing)?

17. Where would you usually get information regarding health issues? Please tick all that apply

18. If you answered 'other' to question 17, please specify below:

19. Roughly how many times have you seen your GP or a hospital doctor in the last year?

20. Have you attended any medical screening in the past (e.g. mammography or bowel scope)?

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

22. Please tell us how you travelled to your appointment?

23. If you selected 'Other' to question 22, please specify below

24. Approximately how many minutes did it take you to get here?

Equality and Diversity monitoring (optional)

25. Do you consider yourself to have a physical disability/impairment?

26. What is your ethnicity?

27. Are you a carer?

Please email TLHCOps@uhs.nhs.uk if you have any questions or are interested in being more involved in the service.

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Thank you for taking the time to complete this survey.

Thank you