Thank you for taking the time to fill in this survey. Your feedback will help us to improve the care we provide.

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* 1. Are you a:

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* 2. Service/ward/area:

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* 3. Thinking about your recent experiences of our service/team, how likely are you to recommend our services/team to friends and family if they needed similar care or treatment?

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* 4. What is your sex

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* 5. What age are you?

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* 6. What is your ethnic group?

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* 7. Are your day to day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months? Include any issues/problems related to old age)

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* 8. Would you like your comments to be made public?

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