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ABC Local Vaccination Service - Patient Feedback
This survey is managed by Alliance for Better Care and is only for our sites.
If the site you had your vaccine is not listed, then ask the team onsite for their feedback survey.
1.
Where did you have your vaccination?
Birchwood Medical, Horley
Caterham Dene Hospital
Clair Hall, Haywards Heath
Community pop-up clinic (Crawley)
Community pop-up clinic (Surrey)
Community pop-up clinic (Coastal)
Home - via your roving team
Care home
2.
Did you receive a Covid-19 vaccination, flu vaccination or both today?
Covid-19
Flu
Both
3.
Have you received a Covid-19 vaccination through this service before?
Yes
No
Don't know
4.
How long was your waiting time?
5 minutes
5 - 10 minutes
10 - 20 minutes
20 - 30 minutes
30+ minutes
5.
I felt well cared for...
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
6.
The environment was clean and Covid-secure...
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
7.
I was given enough information...
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
8.
The staff were positive and happy...
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
9.
Had this outreach service not been in place, would you have sought the Covid-19 vaccination through other routes?
Yes
No
Don't know
10.
If this service is withdrawn, would you go to a GP/vaccination centre in the future for a COVID-19 vaccination? (For those who visited a community/MDU/care home or at home vaccination).
Yes
No
Don't know
11.
How would you rate your overall experience?
Fantastic
Good
Satisfactory
Below expectations
Terrible
12.
Is there anything else the team has helped you with today, or do you have any other comments for our team?
13.
If you are happy to do so, please confirm your age.
18 - 24
25 - 39
40 - 59
60 - 74
75 - 89
90+
14.
If you are happy to do so, please confirm your ethnicity.
Asian/Asian British/Asian Welsh/Asian
Black/Black British/Black Welsh/Caribbean or Africa
Mixed or multiple
Gypsy Roma Traveller / Irish Traveller
White British / White European / White Mixed
Other (please specify)
15.
If you are happy to do so please share your full postcode. (This will not be shared externally but will be used for internal analysis of our data).