Altnagelvin GUM Clinic - Patient Satisfaction Survey

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* 1. Gender

Male

Female

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* 2. Age

Under 18

18-25

26-34

35-44

45-54

55-64

65+

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* 3. Sexual Orientation

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* 4. Where did you find out about the Sexual Health/GUM Clinic?

Other (please specify)

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* 5. How do you believe we could improve advertising of our services?

Other (please specify)

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* 6. How did you attend your most recent appointment?

Booked appointment

Walk in

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* 7. What is your preferred option for attending appointments?

Booked appointment

Walk in

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* 8. Would you use an online booking service?

Yes

No

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* 9. What is your most preferred day of the week to attend the clinic?

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* 10. What would be your most preferred time to attend the clinic?

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* 11. If we were to open an evening clinic which evening would you prefer?

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* 12. If we opened a Saturday morning clinic would you use this service?

Yes

No

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* 13. Would you prefer if this clinic also offered contraception? (Female only)

Yes

No

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* 14. What is your preference of location for this service?

Other (please specify)

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* 15. Where would be your preferred area to attend a GUM Service?

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* 16. How would you rate the service based on the following areas?

	Poor	Fair	Good	Very Good
Telephone access	Telephone access Poor	Telephone access Fair	Telephone access Good	Telephone access Very Good
Length of time you waited to be seen	Length of time you waited to be seen Poor	Length of time you waited to be seen Fair	Length of time you waited to be seen Good	Length of time you waited to be seen Very Good
Ease of finding the clinic	Ease of finding the clinic Poor	Ease of finding the clinic Fair	Ease of finding the clinic Good	Ease of finding the clinic Very Good
Overall experience of the clinic	Overall experience of the clinic Poor	Overall experience of the clinic Fair	Overall experience of the clinic Good	Overall experience of the clinic Very Good

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* 17. Please rate the service based on your experience with staff

	Yes	No
Did the people who dealt with you - Introduce themselves?	Did the people who dealt with you - Introduce themselves? Yes	Did the people who dealt with you - Introduce themselves? No
Did the people who dealt with you - Listen to your concerns?	Did the people who dealt with you - Listen to your concerns? Yes	Did the people who dealt with you - Listen to your concerns? No
Did the people who dealt with you - Take enough time with you?	Did the people who dealt with you - Take enough time with you? Yes	Did the people who dealt with you - Take enough time with you? No
Did the people who dealt with you - Answer any questions you asked?	Did the people who dealt with you - Answer any questions you asked? Yes	Did the people who dealt with you - Answer any questions you asked? No
Did the people who dealt with you - Explain your examination to you?	Did the people who dealt with you - Explain your examination to you? Yes	Did the people who dealt with you - Explain your examination to you? No
Did the people who dealt with you - Provide useful sexual health advice?	Did the people who dealt with you - Provide useful sexual health advice? Yes	Did the people who dealt with you - Provide useful sexual health advice? No
Did the people who dealt with you - Explain lifestyle factors and their impact on your sexual health?	Did the people who dealt with you - Explain lifestyle factors and their impact on your sexual health? Yes	Did the people who dealt with you - Explain lifestyle factors and their impact on your sexual health? No
Was your privacy and dignity maintained?	Was your privacy and dignity maintained? Yes	Was your privacy and dignity maintained? No
Were reception and clinical staff friendly, helpful and supportive to you?	Were reception and clinical staff friendly, helpful and supportive to you? Yes	Were reception and clinical staff friendly, helpful and supportive to you? No

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* 18. Please provide any additional comments/suggestions you may have

Thank you for taking the time to complete this survey