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* 1. How would you rate your overall experience of the Lincolnshire Wheelchair Service?

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* 2. Did you feel you were involved in decisions made about you and your care?

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* 3. Did you feel that our staff listened to you?

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* 4. Did our staff treat you with dignity and respect at all times?

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* 5. How happy were you with the information provided by our service?

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* 6. How happy were you with the time taken?

  Very happy Happy Don't know Unhappy Very unhappy
Waiting time to first appointment
Time taken to assess you during your appointment
Waiting time for equipment

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* 7.  How would you rate the facilities at the clinic thinking about how clean they were and how accessible?

  Very happy Happy Don't know Unhappy Very unhappy
Clinic Room?
Waiting Area?

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* 9. Thinking about your overall experience please tell us one thing we did well and one thing we could improve. Please feel free to use this box for any other comments or feedback you would like to make.

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* 10. Contact us/register for bulletin

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