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A&E / Walk in Centre

Your feedback about your experience and quality of care is important to us. This survey will just take a few minutes to complete and we will use your feedback to better understand what is important to you, what we are doing well and where can make improvements.

Friends and Family Accident and Emergency

is required
Department:   
Department: is required
Date
Date is required
Are you the patient or the patients representative?   
Are you the patient or the patients representative? is required

Thinking about your recent visit to A&E

is required
Overall, how was your experience of our service?
Overall, how was your experience of our service? is required
Please can you tell us why you gave your answer?
Please can you tell us why you gave your answer? is required

We are committed to ensuring that everyone has equal access to our services. We would like your help to do this by answering a few questions about your background. The information will be used to improve the quality of our services.

is required
Do you wish to complete these questions?
Do you wish to complete these questions? is required

Demographics
Which of the following options best describes how you think of yourself?  
Which of the following options best describes how you think of yourself? is required

Is your gender the same as it was assigned at birth?  
Is your gender the same as it was assigned at birth? is required

What age are you?   
What age are you? is required

What is your ethnic group?  
What is your ethnic group? is required

Do you have a disability (any issue or impairment which is likely to last more than 12 months and impact on your ability to carry out everyday activities)?  
Do you have a disability (any issue or impairment which is likely to last more than 12 months and impact on your ability to carry out everyday activities)? is required

Which of the following options best describe how you think of yourself?  
Which of the following options best describe how you think of yourself? is required

What is your religion or belief, even if you are not currently practising?  
What is your religion or belief, even if you are not currently practising? is required