Barnes Hospital - Public Consultation November 2017 Feedback form Question Title * 1. Contact details Name Address Postcode Email Telephone Question Title * 2. Please indicate which of the following apply to you: Live locally Work locally Service user Are a member of a local organisation (If so, please specify which one) Question Title * 3. Please rank the following aspects of the proposals (1 not very important – 5 very important) 1 2 3 4 5 Retention of mental healthcare services and new facilities Retention of mental healthcare services and new facilities 1 Retention of mental healthcare services and new facilities 2 Retention of mental healthcare services and new facilities 3 Retention of mental healthcare services and new facilities 4 Retention of mental healthcare services and new facilities 5 New homes New homes 1 New homes 2 New homes 3 New homes 4 New homes 5 Land to deliver social and community uses Land to deliver social and community uses 1 Land to deliver social and community uses 2 Land to deliver social and community uses 3 Land to deliver social and community uses 4 Land to deliver social and community uses 5 Highways and access Highways and access 1 Highways and access 2 Highways and access 3 Highways and access 4 Highways and access 5 Promotion of sustainable travel Promotion of sustainable travel 1 Promotion of sustainable travel 2 Promotion of sustainable travel 3 Promotion of sustainable travel 4 Promotion of sustainable travel 5 Other (please specify) Question Title * 4. Do you support the outline plans for the future development of Barnes Hospital? Yes No Unsure Neutral Comments Question Title * 5. How did you hear about the event? Email Newsletter Word of mouth Social media Other (please specify) Question Title * 6. Did you find the event informative? Yes No Question Title * 7. Would you like to be kept informed as the Estate Modernisation Programme progresses? If so, how would you like to be updated? I do not wish to be kept informed Email or e-newsletter Newsletter Website updates Done