* 1. Age

* 2. Gender

* 3. Employment Status

* 4. How often have you used any kind of Health Service in the past 12 months?

* 5. Which of these services have you used in the last 12 months? Tick all that apply

* 6. Of all the services you have used in the last 12 months, please tick all the ones that you were happy with.

* 7. Please comment why you were happy with the services you chose.

Please let us know the practice, service or provider name if you can. This helps us highlight good practice. 

* 8. Of all the services you have used in the last 12 months, please tick all the ones that you were unhappy with.

* 9. Please comment why you were unhappy with the services you chose.

Please let us know the practice, service or provider name if you can. This helps us highlight bad practice.

Thank you for completing this short survey for Healthwatch North East Lincolnshire. The information you shared with us  today helps us represent your views of local health & social care services  to commissioners and providers. This will help them to improve by telling them what patients think could be better but at the same time highlighting what works well.

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