Your Opinion Counts Form
Listening to the experiences of people who use our services is very important to us. It helps us to continually improve the services we provide. Please take a moment to complete this form.You do not have to leave your contact details if you do not wish to and your views are still important to us.
We would like you to think about your recent experiences of our service. Overall, how was your experience of our service?
Very Good
Good
Not Good nor Poor
Poor
Very Poor
Don't Know
* Required
Which service or ward are your comments about?
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What parts of the service or your care and treatment were particularly good?
What parts of the service or your care and treatment were not so good?
How could we improve?
Name:
Address:
Patient Name (If different):
Tel no:
Email:
How do you want a reply to your comments?
Phone
Letter
Email
Face to Face
No Reply
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Your comments may be used on our website, but will be anonymous. However, if you would prefer your comments not to be put on the website, please tick this box