Formic Web Forms - [5 FFT Community Adults April 2020

5 FFT Community Adults April 2020

Tell us what you think about the quality of your care!

Equality Monitoring

V1-2020

Alternatively you can complete an online form at https://www.cht.nhs.uk/patients-visitors/family-and-friends-test

Thinking about your recent experience of our Community Service...

Date of feedback:

If yes, please state:

What could we do better?

What went well with your care and treatment?

Which service have you been seen by?

What is your sexual orientation?

Bisexual

Prefer not to say

Heterosexual

Gay-Lesbian

What is your age?

0-15

35-44

55-64

Prefer not
to say

45-54

75+

16-24

65-74

25-34

What is your ethnic group?

Black

White

Other

Asian

Mixed

Prefer not to say

Do you have a disability?

Prefer not to say

Yes

If you DO NOT wish your anonymous comments to be used in our promotional material, please tick here:

I am answering this as a...

Relative/Carer/Advocate
(please answer the questions below
about the patient)

Patient

Are you male or female?

Female

Male

Prefer to use
my own term

Prefer not to say

Overall, how was your experience of our service?

Very
Poor

Good

Neither Good
nor Poor

Very
Good

Don't
know

Poor

Adult SALT

Ageing Well Practitioners

Bladder and Bowel

Cardiac Rehabilitation and Heart Failure

Community Matrons

Dietetics

District Nursing - Lower Valley

District Nursing - Upper Valley

District Nursing - Central

District Nursing - North

District Nursing - Ryburn

Elective Orthopaedic Rehab

Elland and Stainland South Hub

Immunisation Team

Intermediate Care Beds Calderdale

Lymphoedema

OOH Palliative Care

Orthotics

Palliative Care

Parkinsons Nursing

Physiotherapy OPD Community

Podiatry

Pulmonary Rehab

QUEST Team

Respiratory Physiotherapy

Respiratory Team

Support and Independence Team (SIT)

Urgent Community Response (UCR)