FFT Patient Experience Survey

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This question requires an answer

1. Are you? *

Male
Female
Prefer not to answer
Prefer to self describe

2. What age are you?

0-15
16-24
25-34
35-44
45-54
55-64
64-74
75-84
85+

3. Which of the following best describes your ethnic background?

British
Irish
Other White background
Asian or Asian British
Black or Black British
Mixed
Other
Rather not say

4. What best describes your sexuality?

Bisexual
Heterosexual
Gay/Lesbian
Prefer not to say
Prefer to self describe

5. Do you consider yourself to have a disability?

Yes
No

6. Are you?

The Patient
The Parent or Carer
The Patient & Parent/Carer

7. Which service have you used?

8. What was the location of the service?

9. What date did you receive the service?

10. Overall how would you rate your experience of our service?

Very Good
Good
Neither Good nor Poor
Poor
Very Poor
Don't Know

11. Please tell us why you ticked this box?

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