Easy Read FFT

Please tell us about your patient experience

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* 1. Date

Date / Time

Date

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* 2. Name of Ward/Service/Team

We would like you to think about your recent experience of our service.

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* 3. Would you want your friends and family to have this service if they needed it?

Yes

No

Don't know

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* 4. What was good about the visit?

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* 5. What would have made the visit better?

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* 6. olijojo

Please tick this box if you DO NOT wish my comments to be made public

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* 7. What is your sex?

Male

Female

Non-gender conforming

Non-binary

Prefer not to say

Prefer to self-describe

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* 8. How old are you?