This questionnaire has been created to assess services available to people living with dementia in our local communities. Your answers will help us to understand how effective services are, what kind of difference they’re making, and how we can improve them.

Taking part is voluntary and you do not have to answer the questions if you do not want to. We will not report results for any individual.

If you can’t answer a question, feel free to ask for clarification, or just leave it and go on to the next one.

When you have completed the questionnaire, please hand it back to the person who gave it to you.

Question Title

* 1. Please read the following statements and tick the one that applies to you:

Question Title

* 2. I agree to take part in this research by completing questionnaires (please tick)

Question Title

* 3. My town and local area. Please tick the box which best describes how you feel about the following statements:

  Strongly Disagree Disagree Not Sure Agree Strongly Agree
a) I have easy access to my local town/village using public transport
b) I know how I can access mobility aids in my local town/village
c) I feel comfortable socialising in my local town/village
d) I am aware of social activities in my local town/village for people with dementia
e) I know where I can find information about activities for people with dementia in my local town/village
f) I have easy access to my GP or health services in my local town/village
g) I have a network of health professionals including GP’s to support me in my local area
h) I have good communication with health professionals that support me in my local area
i) I find blue badge or other convenient parking spaces easily in my town/village?
j) There are no obstacles (signage, physical, poor lighting, narrow paths) stopping me from moving around my town/village

Question Title

* 4. Awareness. Please tick the box which best describes how you feel about the following statements:

  Strongly disagree Disagree Not sure  Agree Strongly agree
a) Businesses including restaurants have a good understanding of dementia where I am
b) Visual and hearing impairments are well catered for in my local businesses including restaurants
c) The population in my town/village have a good understanding of dementia
d) Public transport in my town/village is dementia friendly
e) I know where the nearest W/C is in my town/village
f) There are places to sit and rest out-side and inside of shops in my local village

Question Title

* 5. Can you suggest anything that can be improved to increase dementia friendliness of your town/village and services locally? This can be in relation to transport, services, signposting, businesses and restaurants, the built environment or anything else you feel we need to know about.

Question Title

* 6. Can you suggest anything that can be improved to increase dementia friendliness and awareness in your local community? This can be in relation to raising awareness and communication.

Question Title

* 7. What is the name of your local town/village?

T