Friends and Family Test Feedback

We would like you to think about your experience of using our services

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* 1. What service did you use?

Inpatient/Ward stay

Outpatient/Clinic

Accident and Emergency

Maternity Services

Other (please specify)

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* 2. Please tell us the name of the ward or department

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* 3. Overall, how was your experience of our service?

Very good

Good

Neither good nor poor

Poor

Very poor

Don't know

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* 4. Please can you tell us why you gave that answer?

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* 5. Please tell us about anything we could have done better

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* 6. Are you male or female?

Male

Female

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* 7. Do you have a disability?

Yes

No

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* 8. If you answered yes to Question 6, what type of disability do you have?

Hearing

Vision

Mobility

Other (please specify)

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* 9. Please state your ethnic origin

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* 10. Please state your religion

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* 11. Are you happy for your comments to be made public

Yes

No