A1 Outpatient Friends and Family Test

English

Outpatient Friends and Family Test Survey

We would like you to think about your experience of our Outpatient Department. By answering the questions it will help us to understand your overall experience. This will help us to measure and improve the quality of care we give at Portsmouth Hospitals University NHS Trust.

Please choose the service you visited:

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

1 Very Good 2 Good 3 Neither good nor poor 4 Poor 5 Very poor 6 Don't know

Notes

2. Please can you tell us why you gave the rating you have. This could include comments on what we did well or could do better?

4000 characters remaining

Next

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

Yes No

Notes

3. Are you?

Male Female Non-binary Other Prefer not to say

Notes

4. What age are you?

0-15 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Notes

5. What is your ethnic group?

White Asian / Asian British Black / African / Caribbean / Black British Mixed / Multiple ethnic groups Other ethnic group Prefer not to say

Notes

6. Are your day to day activities limited because of a health problem or disability which has last, or is expected to last, at least 12 months? (include any issues / problems related to old age)

Yes, limited a lot Yes, limited a little No Prefer not to say

Notes

Thank you

We will use your comments to celebrate positive feedback and identify opportunities to make improvements. Thank you