Details of the Service experienced

Which service are you giving feedback about?

Which area/location or team is this?

Who is completing this survey?

What type of appointment/contact was this?

Where/how did this appointment/contact take place?

Thinking about the service we provide

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

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

2. What was good about your experience?

3. What would make your experience better?

Data we collect from the question in this section helps us to improve how we support patients with communication and information needs. Your feedback will help us to develop staff training and make sure resources are available for people accessing our services.

4. If you need help to communicate or understand information, did we support you (for example, provide an interpreter, Easy Read, large print etc)? Please tell us anything that will help us to understand your experience.

Yes No Not sure Not needed

Comments for question 4

About you (patient/client)

Data we collect from the questions in this section is to ensure that all patients are treated fairly and receive the best standard of care. Knowing more about our patients helps us to identify potential care needs and tailor our services to meet patient needs.

5. Age:

6. Gender identity

Comments for question 6

7. Sexual Orientation

8. Ethnicity

9. Religion/belief

Comments for question 9

10. Do you have a health condition or disability which makes it difficult for you to do everyday things? (this could be mental or physical)

Data we collect from the questions in this section helps us to better understand the unique experiences of the British Armed Forces Community and ensure they receive the best care and support. This includes serving personnel, reservists, veterans or immediate family members.

11. Have you ever served in the British Armed Forces?

12. Has anyone in your immediate family (spouse, civil partner, parents and children) ever served in the British Armed Forces?

Please tick this box if you do not wish your comments to be made public

Adult Experience Survey