Hampshire & IOW NHS wheelchair service friends & family feedback form

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* 1. How has your experience been with us so far?

Very Good

Good

Don't Know

Poor

Very Poor

Neither Good nor Poor

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* 2. Are you the service user, parent/guardian, carer or relative?

Service User

Parent/Guardian

Carer

Relative

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* 3. Please rate our staff helpfulness/politeness?

Excellent

Good

Don't know

Poor

Very Poor

Neither good nor poor

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* 4. Please rate the level of care we provide?

Excellent

Good

Don't Know

Poor

Very Poor

Neither good nor poor

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* 5. Please rate the facilities/cleanliness of the service center in Hampshire and/or Isle of Wight

Excellent

Good

Don't know

Poor

Very Poor

Neither good nor poor

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* 6. Do our staff treat you with compassion, dignity and respect?

Yes

Don't Know

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* 7. Were you involved in discussions in the planning of your care?

Yes

Don't Know

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* 8. Please can you tell us anything we could do better?

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* 9. If you had any problems with your equipment, do you know how to contact our service?

Yes

Don't Know

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* 10. Finally, how satisfied are you with our service?

Very Satisfied

Satisfied

Don't Know

Unsatisfied

Very Unsatisfied

Neither satisfied nor unsatisfied