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Friends and Family Test - Outpatient Visits, Princess Royal Hospital

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.

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

1. Which outpatient clinic did you visit today?

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

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

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

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

Demographics Information

We are asking these questions to ensure that information is being made as accessible as possible to all members of the community and that lots of different people are asked for their views.

We aim to take positive steps to ensure that individuals or groups are not treated less well and that there is no discrimination based on age, race, sex, disability, sexual orientation, marital or civil partnership, gender re-assignment, religion or belief.

The form is confidential and will never be traced back to the patient as an individual. The patient does not have to answer these questions if they do not want to and the demographics can we skipped completely.

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. If you answered ‘yes’ to question 7, 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. What is your first language

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12. Which of the following best describes your gender?

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?

Thank you for completing this survey. All responses received are anonymous.