Easy read Friends and Family Test (FFT) survey

English

Easy read Friends and Family Test (FFT) survey

These questions are a chance for you to tell us what you think about the care you had. Answering these questions will help us to know: if we are doing a good job or if things could be done better.

Please choose the service you visited:

1. Date of visit:

2. Please tell us who is completing this form?

Patient Parent Carer Advocate Other

Notes

3. Which department/ward did you visit?

4000 characters remaining

Notes

4. What did you think of your visit to hospital? Please tick one box only

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

Notes

5. If you needed support or adjustments for your visit, was this provided?

Yes Maybe No N/A

Notes

6. Did staff explain things well?

Yes Maybe No

Notes

7. Did staff listen to you?

Yes Maybe No

Notes

8. Did staff listen to your carer or family?

Yes Maybe No N/A

Notes

9. What was good about your visit?

4000 characters remaining

Notes

10. What would have made your visit better?

4000 characters remaining

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

Yes No

Notes

11. What is your ethnicity?

Asian / Asian British Black / African / Caribbean / Black British Mixed / Multiple ethnic groups White / White British Self-describe Prefer not to say

Notes

12. If you answered 'self-describe', please specify:

4000 characters remaining

Notes