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* 1. Please select one of the following options below to indicate how you currently use these services:

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* 2. What do you currently use this service for?

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* 3. (Core Principle 3) One of our objectives for this service is that users receive an assessment that includes indentifying your/your carers outcomes, an assessment of your/your carers expectations and provision of appropriate equipment where eligible.

Do you feel this reflects your experience of this service?

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* 4. If no please tell us why?

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* 5. (Core Principle 4) Do you feel the time you had to wait from your referral being made to your assessment was acceptable?

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* 6. If no please tell us why?

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* 7. (Core Principle 6) Did you receive regular reviews as part of this service?

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* 8. (Core Principle 6) If yes, do you feel these reviews were useful? Please provide as much detail as you can in the text box below:

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* 9. (Core Principle 7) If you have been provided with equipment, do you feel how you may use this equipment in the future was considered as part of your assessment?

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* 10. If no, how do you think this could be improved?

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* 11. (Core Principle 8) If you have been provided with equipment, do you feel you had enough choice and control over your options in particular to help meet your health, social and/or employment needs?

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* 12. If no, how do you think this could be improved?

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* 13. Do you have any other comments about what you think works well as part of this service?

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* 14. Would you like to make any more comments about what you think could be improved about his service?

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