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* 1. Please indicate below if you are:

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* 2. Was this appointment:

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* 3. If this is a follow up appointment, did you receive an appointment within the time scale advised e.g. 3 months, 6 months.

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* 4. Did you receive a letter informing you about your appointment?

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* 5. Did our staff introduce themselves to you today?

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* 6. Comments:

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* 7. Did you feel you had enough time with the clinicians you saw today?

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* 8. Did you feel that you were given enough opportunity to ask any questions?

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* 9. Comments:

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* 10. Did you feel involved in any decisions about your care?

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* 11. Comments:

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* 12. Did you find the overall length of your visit today:

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* 13. Please tell us why you chose this answer:

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* 14. Did you feel that you had confidence and trust in the clinicians you have seen today?

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* 15. Please tell us why you chose this answer

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* 16. How did you find the Clinic waiting areas today?

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* 17. Please tell us why you chose this answer, or if you chose Other, please tell us how you found the environment:

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* 18. Please tell us 'What Matters To You' when you come to hospital?

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* 19. Please share with us any other feedback or comments you have. We welcome your feedback to help us to improve our services:

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