Feedback Form

1. Share your experience

If you want to have your say and share your experiences with Healthwatch, please complete this form. Your feedback is essential in developing local standards of care so include as much detail as possible.

If you want help or advice, then please use our Helpline Form instead.

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Routing Question - Link Title

This question requires an answer

1. Why are you getting in touch? *

Request for Information
Compliment – giving positive feedback
Concern – raising a concern
Complaint – making a formal complaint
Whistleblowing – reporting a serious issue about your organisation

This question requires an answer

2. What type of service is your feedback about?

Please choose the services that you'd like to tell us about. You can pick more than one.

GP services
Dentist
Pharmacies
Hospital inpatients - overnight treatment
Hospital outpatients - day treatment
Mental health support

Social care - such as care homes and home care
Accident and Emergency / Urgent Treatment Centres / minor injury units
Ambulances and paramedics
NHS 111
Other (please tell us which other services you are referring to)

3. What is the name of the services or organisations your feedback is about?

Such as Royal Sussex County Hospital – Maternity Ward, Brighton Station Medical Centre or Health Visitor, etc.

This question requires an answer

4. Please tell us about your experience.

Give details, including dates and timeline. You may wish to remove any personal information from your feedback, such as names or addresses, etc.

*

5. Which health staff are mentioned in your feedback?

Please choose all that apply.

Administrative
Care/support workers
Dieticians
Doctor/consultant/dentist
Midwives
Nurses
Occupational Therapists

Paramedics
Physiotherapists
Radiographers
Receptionists
Service manager
Social worker

Feedback Form

1. Share your experience

Routing Question - Link Title

1. Why are you getting in touch? *

2. What type of service is your feedback about?Please choose the services that you'd like to tell us about. You can pick more than one.

3. What is the name of the services or organisations your feedback is about?Such as Royal Sussex County Hospital – Maternity Ward, Brighton Station Medical Centre or Health Visitor, etc.

4. Please tell us about your experience.Give details, including dates and timeline. You may wish to remove any personal information from your feedback, such as names or addresses, etc. *

5. Which health staff are mentioned in your feedback?Please choose all that apply.

Routing Question - Volunteer Section

2. What type of service is your feedback about?

Please choose the services that you'd like to tell us about. You can pick more than one.

3. What is the name of the services or organisations your feedback is about?

Such as Royal Sussex County Hospital – Maternity Ward, Brighton Station Medical Centre or Health Visitor, etc.

4. Please tell us about your experience.

Give details, including dates and timeline. You may wish to remove any personal information from your feedback, such as names or addresses, etc.

*

5. Which health staff are mentioned in your feedback?

Please choose all that apply.