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Rate Your Experience
Friends and Family Test Questionnaire
CONTACT US
Thinking about your recent visit...
Overall how was your experience of our service?
Please leave blank:
Please Tick:
Very Good
Good
Neither good nor poor
Poor
Very poor
Don't Know
Please can you tell us why you gave your answer
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and please tell us about anything we could have done better.
Notes:
Optional: About You:
Male
Female
Age Group:
1-15
16-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Do you consider yourself to have a disability?
Please Tick:
No
Yes
Details:
Which of the following best describes your ethnic background?
White:
British
Irish
Other white background
Asian or Asian British:
Indian
Pakistani
Bangladeshi
Chinese
Other Asian background
Mixed:
White & Black Caribbean
White & Black African
White & Asian
Other Mixed Background
Black or Black British:
Caribbean
African
Other Black background
Other:
Anything Else
I would rather not say
Are you?
The Patient
The Parent or carer
The patient & parent/carer
Thank you for completing this survey and providing us with feedback to improve our service. If you DO NOT wish your anonymous comment to be shared then please tick here:
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