Have Your Say: on local health and social care in Lancashire

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* 1. What is your age?

25 or under

26-35

36-45

46-55

56-65

65+

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* 2. What is your gender?

Male

Female

Other (please specify)

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* 3. Please tell us which town you live nearest to?

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* 4. Please choose one of the following health services you would like to tell us about (please complete as many surveys as you like if you would like to tell us about more than one service):

Dentist

Hospital

Optician

Pharmacy

Mental health services

Drug and alcohol services

Other (please specify)

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* 5. What rating would you give this service? (Red is negative, amber is neutral and green is positive)

Red

Amber

Green

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* 6. Please tell us why you gave this rating, why is it important to you? (e.g. how accessible is this service, what is appointment booking like, how do you find the staff, do you feel listened to, would you recommend this service to others?)

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* 7. Please choose one of the following social care services you would like to tell us about (please complete as many surveys as you like if you would like to tell us about more than one service):

Care home

Domiciliary care service

Learning disability support service

Carers support service

Advocacy

Other (please specify)

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* 8. What rating would you give this service? (Red is negative, amber is neutral and green is positive)

Red

Amber

Green

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* 9. Please tell us why you gave this rating, why is it important to you? (e.g. how accessible is this service, how do you find the staff, do you feel listened to, would you recommend this service to others?)

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* 1. What is your age?

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* 2. What is your gender?

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* 3. Please tell us which town you live nearest to?

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* 4. Please choose one of the following ﻿health﻿ services you would like to tell us about (please complete as many surveys as you like if you would like to tell us about more than one service):

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* 5. What rating would you give this service? (Red is negative, amber is neutral and green is positive)

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* 6. Please tell us why you gave this rating, why is it important to you? (e.g. how accessible is this service, what is appointment booking like, how do you find the staff, do you feel listened to, would you recommend this service to others?﻿)

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* 7. Please choose one of the following ﻿social care services you would like to tell us about (﻿please complete as many surveys as you like if you would like to tell us about more than one service﻿):

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* 8. What rating would you give this service? (Red is negative, amber is neutral and green is positive)

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* 9. Please tell us why you gave this rating, why is it important to you? (e.g. how accessible is this service, how do you find the staff, do you feel listened to, would you recommend this service to others?)

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* 10. For office use only.

* 4. Please choose one of the following health services you would like to tell us about (please complete as many surveys as you like if you would like to tell us about more than one service):

* 6. Please tell us why you gave this rating, why is it important to you? (e.g. how accessible is this service, what is appointment booking like, how do you find the staff, do you feel listened to, would you recommend this service to others?)

* 7. Please choose one of the following social care services you would like to tell us about (please complete as many surveys as you like if you would like to tell us about more than one service):