Patient FFT Sensory Explorers 325457

1. We would like you to think about your experience of this service
Overall, how was your experience of our service? *

2. Thinking about the service we provide, please can you tell us why you gave your answer?

3. Please tell us about anything that we could have done better

4. Please put a tick in one of the boxes for each of the questions below

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
Do you feel your child has benefitted from attending the sessions?	Do you feel your child has benefitted from attending the sessions? Strongly agree	Do you feel your child has benefitted from attending the sessions? Agree	Do you feel your child has benefitted from attending the sessions? Neither agree nor disagree	Do you feel your child has benefitted from attending the sessions? Disagree	Do you feel your child has benefitted from attending the sessions? Strongly disagree
Do you feel you have benefitted from attending the sessions?	Do you feel you have benefitted from attending the sessions? Strongly agree	Do you feel you have benefitted from attending the sessions? Agree	Do you feel you have benefitted from attending the sessions? Neither agree nor disagree	Do you feel you have benefitted from attending the sessions? Disagree	Do you feel you have benefitted from attending the sessions? Strongly disagree
Has there been any change to your child's tolerance to dried foods?	Has there been any change to your child's tolerance to dried foods? Strongly agree	Has there been any change to your child's tolerance to dried foods? Agree	Has there been any change to your child's tolerance to dried foods? Neither agree nor disagree	Has there been any change to your child's tolerance to dried foods? Disagree	Has there been any change to your child's tolerance to dried foods? Strongly disagree
Has there been any change to your child's tolerance to wet foods?	Has there been any change to your child's tolerance to wet foods? Strongly agree	Has there been any change to your child's tolerance to wet foods? Agree	Has there been any change to your child's tolerance to wet foods? Neither agree nor disagree	Has there been any change to your child's tolerance to wet foods? Disagree	Has there been any change to your child's tolerance to wet foods? Strongly disagree
Have you been able to introduce new foods to your child?	Have you been able to introduce new foods to your child? Strongly agree	Have you been able to introduce new foods to your child? Agree	Have you been able to introduce new foods to your child? Neither agree nor disagree	Have you been able to introduce new foods to your child? Disagree	Have you been able to introduce new foods to your child? Strongly disagree
Do you have any comments about how we could improve the sessions?	Do you have any comments about how we could improve the sessions? Strongly agree	Do you have any comments about how we could improve the sessions? Agree	Do you have any comments about how we could improve the sessions? Neither agree nor disagree	Do you have any comments about how we could improve the sessions? Disagree	Do you have any comments about how we could improve the sessions? Strongly disagree

5. What age are you?

6. Are you male or female

Male
Female
Prefer not to say
I think of myself as

I think of myself as:

7. The person completing this form

The Patient
A carer
A family member

8. Do you consider yourself to have a physical or mental health condition or disability?

Yes
No

9. What is your ethnic group?

10. 10. Are you happy for your feedback to be published anonymously?

Yes
No

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