**Please note, this survey is not collecting feedback on GP Practices**

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* 2. Have you attended a service within the last 3 months, 6 months or 1 year; and excluding general practice?

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* 3. Are you filling in this questionnaire on behalf of yourself or someone else?

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* 4. Please specify the most applicable to your relationship with the service:

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* 5. Please answer the following questions:

  At all times Most of the time Sometimes Rarely Never Not applicable
1. Are you involved as much as you want to be in decisions about care and treatment?
2.    Do you get answers to your questions:
a.    at the time you need them?
b. in a way that you can understand and remember?
3. Do you feel that services are easy to access when needed? 
4. Is the service able to respond to your needs in a suitable timeframe?
5. Do the different professionals involved in your/patient’s care work well together to deliver good care in a timely way?
6. Do you feel that following the information and care you received, you have a better understanding of your/patient’s condition?
7. Do you feel staff do everything they can to respect privacy and address comfort?

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* 6. We are interested to learn about your experience of the service, please tell us what went well or where improvements could be made.

(This could include ways to access care, who provides the care and where the care is provided)

Please include any other information you would like us to know.

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* 7. If you are would like us to contact you further regarding your experience of the services over the next 12-18 months, please leave your contact details in the space provided. We will not be passing these details on to our partners or third party organisations.

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