Harpenden Dementia Survey

Harpenden Town Council would like to hear your views on living with dementia in your local area. This survey is for anyone living with dementia in Harpenden, or to be completed by their carers or family who may accompany them within the town.

This survey template was developed in alignment with the Alzheimer's Society parameters and guidance.

Question Title

* 1. When out in your local area, what sort of things do you do? Choose all that apply.

I’m not able to get out

Shopping

Visiting family and friends

Library & museums

Doctor or hospital appointments

Church or religious group

Activity club or community group

Walks, runs or other outdoor activity

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* 2. Are there things that you used to do, but have stopped doing? Choose all that apply.

Shopping

Visiting family and friends

Library & museums

Doctor or hospital appointments

Church or religious group

Activity club or community group

Walks, runs or other outdoor activity

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* 3. What might help you start doing the activities you indicated you no longer partake in?

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* 4. How important are the things below, so you feel able to go out in your local area?

	Not important	Neutral	Very important
People who understand me	People who understand me Not important	People who understand me Neutral	People who understand me Very important
Friends, family or carers	Friends, family or carers Not important	Friends, family or carers Neutral	Friends, family or carers Very important
Easy to read signs	Easy to read signs Not important	Easy to read signs Neutral	Easy to read signs Very important
Public toilets	Public toilets Not important	Public toilets Neutral	Public toilets Very important
Public transport	Public transport Not important	Public transport Neutral	Public transport Very important
Accessible buildings	Accessible buildings Not important	Accessible buildings Neutral	Accessible buildings Very important
Parking	Parking Not important	Parking Neutral	Parking Very important
Safe pavements, pathways and roads	Safe pavements, pathways and roads Not important	Safe pavements, pathways and roads Neutral	Safe pavements, pathways and roads Very important

If you would like to tell us more about your answers or list other things, fill in the box below:

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* 5. Do you feel you live well with dementia?

Yes, most of the time

Yes, sometimes

No, I struggle

No, I feel I need help

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* 6. What makes you feel that way?

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* 7. In your local area, how would you rate public awareness of dementia?

Very good

Good

Average

Poor

Very poor

Harpenden Dementia Survey

Question Title

* 1. When out in your local area, what sort of things do you do? Choose all that apply.

Question Title

* 2. Are there things that you used to do, but have stopped doing? Choose all that apply.

Question Title

* 3. What might help you start doing the activities you indicated you no longer partake in?

Question Title

* 4. How important are the things below, so you feel able to go out in your local area?

Question Title

* 5. Do you feel you live well with dementia?

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* 6. What makes you feel that way?

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* 7. In your local area, how would you rate public awareness of dementia?

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* 8. What examples can you share of living with dementia in your local area?