Your Easy Read COVID-19 Experience Survey

Please take some time and carefully read the questions below. It's all about your experiences

PART 1 - Your Experiences of Health and Social Services

Question Title

* 1.
Would you like to give feedback about health or social services?

Yes

Question Title

* 2. If YES, which service would you like to tell us about?

Hospital

Ambulance

GP Practice

Pharmacy

Dentist

Optician

Residential/Nursing Home

Care in YOUR OWN home

Mental Health Services

NHS 111

Question Title

* 3. What is the name of the Doctors, Ward or Dentist that you use?

Question Title

* 4. How was your experience using this service?

Very Bad

Bad

Okay

Good

Very Good

Very Bad

Bad

Okay

Good

Very Good

Question Title

* 5. What happened that you want to tell us about?

Question Title

* 6. When did this take place? (Don't worry if you cannot remember, give us an estimate)

Date / Time

Date

Question Title

* 7. What could have been better with your service?

Question Title

* 8. Would you like to talk to us about your experience?

Yes

Your Easy Read COVID-19 Experience Survey

Question Title

* 1. Would you like to give feedback about health or social services?

Question Title

* 2. If YES, which service would you like to tell us about?

Question Title

Question Title

* 3. What is the name of the Doctors, Ward or Dentist that you use?

Question Title

Question Title

* 4. How was your experience using this service?

Question Title

Question Title

* 5. What happened that you want to tell us about?

Question Title

Question Title

* 6. When did this take place? (Don't worry if you cannot remember, give us an estimate)

Question Title

Question Title

* 7. What could have been better with your service?

Question Title

Question Title

* 8. Would you like to talk to us about your experience?

* 1.
Would you like to give feedback about health or social services?