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Friends and Family Test
We would like you to think about your recent visit...
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Please choose the service you visited:
Select the service
Acer Unit
Acute Medical Unit (AMU)
Aspen
Beech
Birth Centre
Breast OPD DVH (Empress)
Car Park
Cedar
Chaplaincy Services
Cherry
Chestnut
Children's Emergency Department
Children's Resource Centre (CRC)
Children's Resource Centre (CRC)
Children's day case/ day surgery
Children's/Paediatric Assessment Unit (PAU)
Community Midwives
DVH Ultrasound
Discharge Lounge
EPU / GAU
Ebony
Endoscopy DVH
Evergreen (CoE OPD DVH)
Fracture Clinic DVH
Heart Centre
Holly
Hospital at Home Team
Hydrotherapy
ICU
Jade Unit
Jasmine Team
Juniper
Labour Ward
Laurel
Linden
Maple
Maxillofacial
Mulberry
Nutrition & Dietetics
Oak
Occupational Therapy
Outpatient Area DVH
PALS/Complaints
Palliative Care
Palm
Pharmacy
Phlebotomy DVH
Physio Dept DVH
Pine Therapy Unit
Plaster room
Poplar
Pre-Assessment DVH
Radiology OPD DVH
Redwood
Rosewood
Rowan
SDEC Ambulatory Emergency Care (AEC)
Sapling (Maternity Antenatal Clinic)
Security Department
Speech & Language Therapy (SLT)
Spruce
Surgical Admissions Lounge (SAL)
Surgical Assessment Unit (SAU)
Voluntary Services
Walnut (Special Care Baby Unit -SCBU)
Willow
Overall, how was your experience of our service?
Very good
Good
Neither good nor poor
Poor
Very poor
Don't know
Notes
Please can you tell us why you gave your answer or what we could have done better?
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Can we share your comment publicly (for example, on our website or printed material such as posters)?
Yes
No
Notes
Optional questions
Are you:
The Patient
Their Carer
Their Parent/Guardian
Their partner
Notes
How old are you?
0-5 years
6-10 years
11-18 years
18-25 years
25-34 years
35-44 years
45-54 years
55-64 years
65-74 years
75-84 years
+85 years
Prefer not to say
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How do you describe your gender?
Male
Female
Non-binary
Prefer not to say
Other (please specify)
Notes
Is your gender identity the same as the sex you were assigned at birth?
Yes
No
Prefer not to say
Notes
How do you describe your ethnic background?
White British
White Irish
Gypsy or Irish Traveller
Roma
Any other White background
White background
Notes:
White background
White British
White Irish
Gypsy or Irish Traveller
Roma
Any other White background
Notes:
Black background
Black British
Black Caribbean
Black African
Any other Black background
Notes:
Black British
Black Caribbean
Black African
Any other Black background
Black background
Notes:
Asian background
Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Notes:
Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Asian background
Notes:
Mixed or multiple ethnic groups
White and Black Caribbean
White and Black African
White and Asian
Any other mixed or multiple ethnic background
Notes:
White and Black Caribbean
White and Black African
White and Asian
Any other mixed or multiple ethnic background
Mixed or multiple ethnic groups
Notes:
Other ethnic group (please specify)
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characters remaining
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Notes
Which of the following best describes your sexual orientation?
Heterosexual/Straight
Homosexual/Gay/Lesbian
Bisexual
Other (please specify)
Prefer not to say
Notes
Do you have any of the following?
A long-standing physical illness or condition
A mental health condition
A learning disability
Blind or partially sighted
Deaf or hearing impairment
Other (please specify)
Prefer not to say
None of the above
Notes
Are you a veteran or serving member of the Armed Forces or the immediate family member or spouse of someone who is?
Yes
No
Prefer not to say
Notes
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