Having viewed the presentation 'improving ophthalmology (eye health) services in Waltham Forest' please complete the following questionnaire.

* 1. In the past 18 months, have you or someone you care for needed treatment for an eye health problem (such as Glaucoma, Cataracts, Eye Injury?)

* 2. Which ophthalmology service(s) did you receive?

* 3. How easy or difficult was it to access the location where your appointment was held?

* 4. How could access to services be improved?

* 5. How would you rate your experience of the service?

* 6. Please provide any feedback on what worked well, and what needs to improve

* 7. Having viewed http://www.walthamforestccg.nhs.uk  'Improving ophthalmology services in Waltham Forest' (slide 4) do you agree that the current model requires change?

* 8. Having viewed 'Improving ophthalmology services in Waltham Forest' (slide 5) do you agree with the CCG's proposal model for ophthalmology services?

* 9. Is there anything else you think we need to consider?

* 10. Please tell us a little about yourself.  This section is NOT compulsory. If you wish to remain anonymous, your view will still be taken into account, however, we would be grateful if you would fill in some of this section so that we can understand where there are differences in the answers given by different groups of people.
 Are you providing this response:

* 11. Name:

* 12. Would you like to be kept up to date with information about the NHS (including this programme)?

* 13. Are you employed by the NHS?

* 14. What is your age?

* 15. What is  your gender?

* 16. Are you a resident of Waltham Forest?

* 17. What part of the borough do you live in?

* 18. Ethnic Background (please click box that refer to you)

* 19. What belief or religion if any, do you most identify with?

* 20. Do you consider yourself to have a disability?

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