We would value your feedback regarding your attendance at the Diabetes Village at the Merlyn Vaz Health Centre.
Please answer the questions below. Your responses are important in the development of the Village.

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* 1. How did you hear about the Diabetes Village?

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* 2. Did you visit the Merlyn Vaz Health and Social Care Centre today, specifically to use the services at the Diabetes Village?

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* 3. Is this the first time you have used the Diabetes Village?

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* 4. If you have ticked yes, how many times have you visited the Village before?

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* 5. Which services did you use?

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* 6. How would you rate your experience?

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* 7. How would you rate the location of the Diabetes Village?

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* 8. Would you attend the Diabetes Village again?

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* 9. Would you recommend the Diabetes Village to family and friends?

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* 10. Was it beneficial having all services under one roof?

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* 11. Do you have any further comments you wish to make? Is there anything else you wish to see at the Diabetes Village?

Equality Monitoring
Please complete as much of the information about yourself as you feel comfortable with, as this will help us understand who is taking part in the consultation. The information you provide will be kept in accordance with the terms of the Data Protection Acts 1998 and 2000 and will be used for monitoring purposes and questionnaire analysis.

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* 12. What is your gender?

Gender reassignment

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* 13. Has your gender (sex) changed since birth?

Pregnancy/Maternity

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* 14. Are you pregnant or have you given birth in the last 26 weeks?

Age

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* 15. What is your age?

Disability

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* 16. Do you consider yourself to have a disability or suffer from poor health?

Condition

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* 17. If you have selected ‘yes’, please tell us which condition:

Race

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* 18. What is your ethnicity?

Religion or Belief

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* 19. What is your religion or belief?

Relationship Status

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* 20. What is your relationship status?

Sexual Orientation

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* 21. What is your sexual orientation (preference)?

0 of 21 answered
 

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