Services Survey - 2022

Please complete this survey to let us know how we can best help and support you.

Thank you for your time; your feedback is much appreciated.

A. About your needs

Question Title

* 1. A1.1 What kinds of things do you, or the person you care for, need help and support with?
Please tick any boxes that apply below.

Finance and paperwork

Low income and benefits
(Eg checking your entitlements, applying for financial support)

Help with financial matters
(Eg pensions, dealing with utility bills, banking)

Help with form-filling
(Eg disabled parking permits, housing, Council Tax Reduction etc)

Help with general paperwork
(Eg writing letters, sorting out paperwork)

Question Title

* 2. A1.2 Health needs
Please tick any boxes that apply below.

Help to deal with home care services
(Eg arranging care, how to pay for care, liaising with Social Services)

Help with residential care homes
(Eg finding a care home, funding live-in care, making a complaint)

Personal care
(Eg dressing, bathing, help with eating)

Physical help
(Eg help with walking, getting up and down stairs)

Help with footcare / nail-cutting

Falls prevention advice
(Eg adapting your home, mobility aids, care alarms)

Taking medicines / changing dressings

How to look after my health and wellbeing
(Eg opportunities to exercise, take up a new hobby / activity, eating well)

Question Title

* 3. A1.3 Practical support
Please tick any boxes that apply below.

Support with daily living
(Eg preparing meals, shopping, housework, gardening)

Help with your home
(Eg staying safe at home, home adaptations, housing options)

Keeping warm at home
(Eg reducing energy bills, installing energy-efficiency measures)

Future planning
(Eg making a will, arranging Power of Attorney, retirement planning)

Accessing local services
(Eg Council services, public transport, health services)

Consumer issues
(Eg scams, finding a trusted trader, complaining about a purchase)

Discrimination
(Eg age-related discrimination in employment)

Help to use the internet, emails, access services on websites etc

Support to care for someone
(Eg arranging respite breaks, emergency planning, Carer’s Allowance)

Question Title

* 4. A1.4 Social and wellbeing
Please tick any boxes that apply below.

Seeking company
(Eg home visits, talking together, playing cards or games, telephone friendship calls)

Support to get out and about
(Eg going for a walk or drive, seeing friends or relatives, visiting social clubs)

Volunteering opportunities

Emotional support / family and personal matters

Domestic, financial or other forms of abuse

Local services and support in your community

Question Title

* 5. A1.5 Other help and support
Are there any other issues that you would like help and support with?
(Please specify)

Question Title

* 6. A2. Do you, or the person you care for, need help and support due to any of the following reasons?
Please tick any boxes that apply below.

Physical disability

Mental health condition

Memory / cognitive problems

Dementia

In financial debt

Autistic spectrum condition

Sight loss or hearing loss

Learning disability

Long-term illness

Relationship / family breakdown

Alcohol or drug addiction

Terminal illness

Bereavement

Other (please specify)

Services Survey - 2022

Question Title

* 1. A1.1 What kinds of things do you, or the person you care for, need help and support with? Please tick any boxes that apply below. Finance and paperwork

Question Title

* 2. A1.2 Health needsPlease tick any boxes that apply below.

Question Title

* 3. A1.3 Practical supportPlease tick any boxes that apply below.

Question Title

* 4. A1.4 Social and wellbeingPlease tick any boxes that apply below.

Question Title

* 5. A1.5 Other help and supportAre there any other issues that you would like help and support with?(Please specify)

Question Title

* 6. A2. Do you, or the person you care for, need help and support due to any of the following reasons?Please tick any boxes that apply below.

* 1. A1.1 What kinds of things do you, or the person you care for, need help and support with?
Please tick any boxes that apply below.

Finance and paperwork

* 2. A1.2 Health needs
Please tick any boxes that apply below.

* 3. A1.3 Practical support
Please tick any boxes that apply below.

* 4. A1.4 Social and wellbeing
Please tick any boxes that apply below.

* 5. A1.5 Other help and support
Are there any other issues that you would like help and support with?
(Please specify)

* 6. A2. Do you, or the person you care for, need help and support due to any of the following reasons?
Please tick any boxes that apply below.