MS Society Northern Ireland Survey

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* 1. Which of the following statements best describes you?

I have MS

I have a friend, family member or care for someone with MS

I am a professional working with people with MS

Other

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* 2. How important do you feel having access to the following types of services is for people with MS?

	Very Important	Important	Not Important	Don't Know
Advice Service	Advice Service Very Important	Advice Service Important	Advice Service Not Important	Advice Service Don't Know
Carer Support	Carer Support Very Important	Carer Support Important	Carer Support Not Important	Carer Support Don't Know
Benefits Guidance	Benefits Guidance Very Important	Benefits Guidance Important	Benefits Guidance Not Important	Benefits Guidance Don't Know
MS Local Support Groups	MS Local Support Groups Very Important	MS Local Support Groups Important	MS Local Support Groups Not Important	MS Local Support Groups Don't Know
MS Helpline	MS Helpline Very Important	MS Helpline Important	MS Helpline Not Important	MS Helpline Don't Know
Advocacy	Advocacy Very Important	Advocacy Important	Advocacy Not Important	Advocacy Don't Know
Respite	Respite Very Important	Respite Important	Respite Not Important	Respite Don't Know
Reflexology / Therapies	Reflexology / Therapies Very Important	Reflexology / Therapies Important	Reflexology / Therapies Not Important	Reflexology / Therapies Don't Know
Publications / MS Information	Publications / MS Information Very Important	Publications / MS Information Important	Publications / MS Information Not Important	Publications / MS Information Don't Know
Social Activities	Social Activities Very Important	Social Activities Important	Social Activities Not Important	Social Activities Don't Know
Physical Activity	Physical Activity Very Important	Physical Activity Important	Physical Activity Not Important	Physical Activity Don't Know
Counselling	Counselling Very Important	Counselling Important	Counselling Not Important	Counselling Don't Know

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* 3. What additional services/activities do you feel you or others with MS could benefit from?

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* 4. What additional services/activities do you feel carers and family members of those with MS could benefit from?

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* 5. Either as someone with MS or as a carer what are the top three difficulties you experience in trying to access services / activities?

Biggest difficulty

2nd biggest difficulty

3rd biggest difficulty

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* 6. If you would be willing to be part of a focus group to help MS Society consider how it might develop services to better support those with MS and their carers please provide us with the information below.

Name

City/Town

Email Address

Mobile Phone Number

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* 7. Are you currently involved in the MS Society?

Yes

If involved, can you please describe how?

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* 8. If you would occasionally like to help the MS Society think further, over time, about how it designs it services please provide your name and email and the MS Society will contact you in that regard.

Name

Email Address

Thank you for the valuable information you have provided that will help us as we continue to provide services for those with MS and their carers.