We would like you think about your recent experiences of our service/team

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* 1. Which Service/Ward/Team is this about?

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* 2. Thinking about your recent experiences of our services/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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* 3. Is there anything we can do to make things better?

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* 4. Are you a:

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* 5. What is your sex?

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* 6. What is your ethnic group?

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* 7. What age are you?

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* 8. 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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* 9. Please tick this box if you DO NOT wish your comments to be made public

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