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* 1. Which site did you attend? (Please choose the site from the dropdown)

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* 2. Did you have a booked appointment time?

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* 3. If YES how long did you wait to be seen?

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* 4. I am the.... (please choose from the dropdown)

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* 5. What is your age?

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* 6. What date did you use our service?

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* 7. Thinking about your recent visit, overall what was your experience of our service?

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* 8. Please use the box below to tell us anything we could have done better....

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* 9. Please use the box below to tell us about anything you felt we did particularly well....

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* 10. Receiving feedback from patients is valuable to NEMS as this allows us to improve the service that we offer. 

If you DO NOT wish for your comments to be shared please
indicate in the box below.

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* 11. If you would like to contact the Quality Governance team to
discuss anything further please email as below for the attention of the Quality Governance Manager.

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