Gluten-free foods on prescription survey

Please take a few moments of your time to help us get you views on the provision of gluten-free foods on prescription. All feedback is greatly appreciated.

1. Consultation survey on gluten-free foods on prescription
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1. Which of the following applies to you?

I have coeliac disease
I am a carer of or I am responding on behalf of an adult with coeliac disease
I am a resident of the Isle of Wight. I do not have coeliac disease
I am a clinician (GP, Nurse, consultant). Please tell us your role in the comments box
Other (please specify):

Comments:

2. If you live on the Isle of Wight, please tell us the name of your GP practice?

3. Do you (or the person you care for) receive gluten-free foods through NHS (Wightbread service or other)? If the answer is no, please go to question 7. (Please tick the relevant box)

4. Q4. Which gluten-free foods do you receive through the NHS? (Tick each relevant box)

Biscuits
Bread
Cereals
Crackers
Flour
Ingredients

5. How many items do you order a month? (Please tick one box only)

0-4
5-8
9-12
13-16
17-20
More than 20

6. What could we do to support people with coeliac disease to better manage their condition?

7. The Isle of Wight (IW) Clinical Commissioning Group (CCG) is consulting on reducing prescribing gluten-free foods in this financial year and stopping prescribing from April 2017 for the reasons given in the consultation document. To what extent do you agree or disagree with this proposal? (Please tick one box)

Strongly agree
Agree
Not sure
Disagree
Strongly disagree

Gluten-free foods on prescription survey

1. Consultation survey on gluten-free foods on prescription
Page 1 of 2

1. Which of the following applies to you?

2. If you live on the Isle of Wight, please tell us the name of your GP practice?

3. Do you (or the person you care for) receive gluten-free foods through NHS (Wightbread service or other)? If the answer is no, please go to question 7. (Please tick the relevant box)

4. Q4. Which gluten-free foods do you receive through the NHS? (Tick each relevant box)

5. How many items do you order a month? (Please tick one box only)

6. What could we do to support people with coeliac disease to better manage their condition?

8. If you are not sure, or if you disagree, please tell us why

9. Is there anything else you would like to share with us?

Gluten-free foods on prescription survey

1. Consultation survey on gluten-free foods on prescriptionPage 1 of 2

1. Which of the following applies to you?

2. If you live on the Isle of Wight, please tell us the name of your GP practice?

3. Do you (or the person you care for) receive gluten-free foods through NHS (Wightbread service or other)? If the answer is no, please go to question 7. (Please tick the relevant box)

4. Q4. Which gluten-free foods do you receive through the NHS? (Tick each relevant box)

5. How many items do you order a month? (Please tick one box only)

6. What could we do to support people with coeliac disease to better manage their condition?

8. If you are not sure, or if you disagree, please tell us why

9. Is there anything else you would like to share with us?

1. Consultation survey on gluten-free foods on prescription
Page 1 of 2