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Friends and Family Test - Emergency Department Survey

We appreciate you taking the time to complete this survey, it helps The Shrewsbury and Telford Hospital Trust understand how Patients and Families feel about the care we provide.

The form is confidential and will never be traced back to you as an individual.

Please note, all demographic data is optional. Please skip this part of the survey if you prefer not to fill in the questions.


1. On what date did you visit the Emergency Department (A&E)?

2. Thinking about your stay in hospital, how was your experience of our service ?

3. What do you feel has been good about the care or experience you have received ?

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4. Do you want to tell us anything else about your visit and what we could improve ?

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5. Please confirm that you are happy for us to publish your comments anonymously ?

Demographics Information

Demographic information is important to us. It tells us who we are reaching in our community. From the information we gather we can tell which people we are not reaching. We can then try and engage with those groups. We want to hear views from as many groups as possible. This helps us to improve our services for everyone. You do not have to fill in the questions. You can skip some of them if you prefer. Your answers are confidential. We cannot identify you if you fill them in.

6. If you would prefer not to respond to this next section covering demographics, please move to the end of the survey by clicking on move to end of survey option

7. What age group are you in ?

8. Are your day-to-day activities restricted due to a health problem, disability or other impairment which has lasted, or is expected to last, at least 12 months (include any problems related to old age)?

9. Please indicate your health condition, disability or other impairment and tick all sections which apply:

10. What is your ethnic group? Tick the appropriate box to indicate the patient ethnic group.

11. Which of the following best describes your gender?

12. What is your first language

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13. Trans is an umbrella term to describe people whose gender is not the same as the sex they were assigned at birth. Do you consider yourself to be a trans person?

14. Which of the following best describes your sexual orientation?

15. What is your legal marital or civil partnership status?

16. What is your faith or belief?

17. Do you look after, or give any help or support to family members, friends, neighbours or others because of either long-term physical or mental ill-health / disability, or problems related to old age?

18. Are you a veteran, including National Service, or do you have a connection to the Armed Forces?