Safe Spaces

This survey has 8 questions and will take only 5 minutes to complete. These questions relate to the time since you opened the Consultation Room at your pharmacy as a Safe Space for victims of domestic abuse.

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* 1. When did you join Safe Spaces? (month/year)

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* 2. What is your pharmacy’s postcode?

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* 3. Since Safe Spaces was launched in your pharmacy, how many customers have used the consultation room to access information, services or enquired about the Safe Space scheme at your pharmacy?

1-10

11-20

21-30

31-40

41-50

51+

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* 4. On average, how many times is a Safe Space in your pharmacy used per month?

10+

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* 5. How successful do you think the scheme has been in supporting your customers experiencing domestic abuse?

Scale 1 to 5 (1=very unsuccessful, unsuccessful, neutral, successful, 5=very successful)

1 = very unsuccessful

2 = unsuccessful

3 = neutral

4 = successful

5 = very successful

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* 6. Since adopting Safe Spaces, has your staff’s confidence in handling disclosures from customers about domestic abuse improved?

Scale 1 to 5 (1=stayed the same, slight confidence, confident, quite confident 5=very confident)

1 = stayed the same

2 = slight confidence

3 = confident

4 = quite confident

5 = very confident

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* 7. How important is it that pharmacies continue to offer Safe Spaces to victims of domestic abuse?

Scale 1 to 5 (1=Not Important, Quite Important, Neutral, Important, 5=Very Important)

1 = not important

2 = important

3 = neutral

4 = quite important

5 = very important

Safe Spaces

Question Title

* 1. When did you join Safe Spaces? (month/year)

Question Title

* 2. What is your pharmacy’s postcode?

Question Title

* 3. Since Safe Spaces was launched in your pharmacy, how many customers have used the consultation room to access information, services or enquired about the Safe Space scheme at your pharmacy?

Question Title

* 4. On average, how many times is a Safe Space in your pharmacy used per month?

Question Title

* 5. How successful do you think the scheme has been in supporting your customers experiencing domestic abuse? Scale 1 to 5 (1=very unsuccessful, unsuccessful, neutral, successful, 5=very successful)

Question Title

* 6. Since adopting Safe Spaces, has your staff’s confidence in handling disclosures from customers about domestic abuse improved?Scale 1 to 5 (1=stayed the same, slight confidence, confident, quite confident 5=very confident)

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* 7. How important is it that pharmacies continue to offer Safe Spaces to victims of domestic abuse?Scale 1 to 5 (1=Not Important, Quite Important, Neutral, Important, 5=Very Important)

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* 8. Please use the space below to add any comments on the scheme?

* 5. How successful do you think the scheme has been in supporting your customers experiencing domestic abuse?

Scale 1 to 5 (1=very unsuccessful, unsuccessful, neutral, successful, 5=very successful)

* 6. Since adopting Safe Spaces, has your staff’s confidence in handling disclosures from customers about domestic abuse improved?

Scale 1 to 5 (1=stayed the same, slight confidence, confident, quite confident 5=very confident)

* 7. How important is it that pharmacies continue to offer Safe Spaces to victims of domestic abuse?

Scale 1 to 5 (1=Not Important, Quite Important, Neutral, Important, 5=Very Important)