Help us to shape our new service for Plastic and Reconstructive Surgery

Barnsley Hospital NHS Foundation Trust is excited to introduce a new Plastic Surgery service in October 2020 onwards. We would appreciate your thoughts on how we can shape the service to meet our patient’s needs. Read more about the background to this proposal on our website.

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* 1. Do you think it will be beneficial to have a plastic surgery service at Barnsley Hospital?

Yes

Please give a reason for your answer.

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* 2. Have you had Plastic or Reconstructive Surgery in the past?

Yes

If Yes, where did you have your procedure, and what was your experience like?

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* 3. How far are you willing to travel to access a Plastic Surgery service?

Up to 30 minutes

Up to 45 minutes

Up to 1 hour

Over 1 hour

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* 4. How do you usually travel?

Walk

Cycle

Car

Public transport

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* 5. Would you like to make any comments about this proposed plastic and reconstructive surgery service?

So that we can try to ensure that our survey is representative of our patients, we would like you to complete the short monitoring section below.

The information provided will only be used for the purpose it has been collected for and will not be passed on to any third parties. You do not have to answer all of these questions, but we would be very grateful if you would.

Data Protection Statement: All information will be kept strictly confidential and in accordance with the Data Protection Act and associated protocols.

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* 6. What is your age?

Under 18

18-24

25-34

35-44

45-54

55-64

65-74

75+

Prefer not to say

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* 7. Please tell us the first part of your postcode in the box provided below (e.g. S75)

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* 8. What is your gender?

Male

Female

Prefer not to say

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* 9. Do you live and work permanently in a gender other than the one you were born into?

Yes

Prefer not to say

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* 10. How would you describe your ethnicity?

White – UK

White – Irish

White – Gypsy or Traveller

Other White Background

Black African

White and Black African

Black Caribbean

White and Black Caribbean

Other Black Background

Chinese

Arab

Indian

Pakistani

Bangladeshi

White and Asian

Other Asian Background

Other Mixed/ Multiple Ethnic Background

Other Ethnic Group (Please state here)

Prefer not to say

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* 11. How would you describe your sexual orientation?

Bisexual

Lesbian

Gay

Heterosexual

Prefer not to say

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* 12. How would you describe your religion?

No religion

Buddhist

Hindu

Sikh

Christian

Jewish

Muslim

Agnostic

Prefer not to say

Other (please state)

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* 13. Do you have any of the following disabilities? (Please tick all that apply)

I do not have a disability

Mental Health Condition

Physical Impairment

Cognitive Impairment

Long Standing Illness

Speech Impairment

Sensory Impairment

Learning Disability

Learning Difficulty

Prefer not to say

Other (please specify)

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* 14. Do you provide unpaid care for someone?

Yes

Prefer not to say