Your Experience Matters

Please choose the service you visited:

Which of the following best describes you?

I use the services myself. I am the family, friend, or carer of someone who uses the services.

What was good about your experience?

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Yes No

Thinking about the service we provide, please tell us how you felt about…

How caring are our staff?

Very good Good Neither good nor poor Poor Very poor Not applicable / Don't know

Being included in decisions about the care provided?

Very good Good Neither good nor poor Poor Very poor Not applicable / Don't know

Staff taking the time to understand you?

Very good Good Neither good nor poor Poor Very poor Not applicable / Don't know

How confident are you in the care we provide?

Very good Good Neither good nor poor Poor Very poor Not applicable / Don't know

Overall, how was your experience of our service?

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

About You

I am happy to answer demographic questions I would prefer not to answer demographic questions

Which of the following best describes your sexual orientation?

Heterosexual / Straight Gay / Lesbian Bisexual I would prefer not to say Other orientation

Please write in:

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Buddhist Christian Hindu Jewish Muslim Sikh No religion I would prefer not to say Other religion

Please write in:

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Yes No I would prefer not to say

If yes, does this reduce your ability to carry out day-to-day activities?

Yes, a lot Yes, a little No, not at all

At birth your registered gender was...

Male Female Intersex Prefer not to say

Is your gender the same as the sex you were registered as at birth?

Yes No Prefer not to say

Please write your gender

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Please write in:

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18 and under 19 - 29 30 - 39 40 - 59 60 - 80 80+ I would prefer not to say