We would like your feedback on a recent referral you made to the ACE (croup) service. This will help us evaluate and improve it. The estimated time to complete it is 5 - 10 mins. Thank you for taking the time to do this. 

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* 1. Please tell us your role.

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* 2. How did you hear about the ACE service? 

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* 3. Did you get through to the ACE team on your first call?

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* 4. Was the referral crib sheet easy to use?

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* 5. Was the referral process easy?

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* 6. Were you happy with the level of contact you had with the team? 

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* 7. Was the information we provided on discharging the child adequate, timely and clear?

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* 8. What could we do better? How could we improve this service or process?

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* 9. Please use this space to give us any other feedback, or to make suggestions of other pathways  you think this model could be applied to. 

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* 10. How happy were you with the level of contact you had with the ACE team after referral’

 
Very happy
Quite happy
Not very happy
Not at all happy

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* 11. Would you use the service again?

T