Friends & Family

The Friends & Family Feedback Form gives you a voice. It is assessed by our Patient Advice and Liaison Team and the results reported, at the highest level, to our Executive Team and, ultimately, to the Department for Health and Social Care.

In order that we can work to address healthcare inequalities, we ask some questions about who you are: you do not have to answer these, but it will really help us to ensure that we are providing the very best healthcare to all sections of our community — so we would be really grateful if you do.

Have your say

Please fill in the below as honestly as possible.

Core Feedback

Note: Questions marked by * are mandatory

When you submit this form, the information you provide will be securely stored and used only for the purpose stated. We will not share your details with third parties without your consent, and your data will be handled in line with our Privacy Policy and UK GDPR requirements.

* I agree to the above data processing.

*This is a mandatory field.

What department(s) is this feedback for?

A&E

Maternity

Oncology

Orthopaedics

Paediatrics

*This is a mandatory field.

Overall, how was your experience of our service?

Very good

Good

Neither good nor poor

Poor

Very poor

Don't know

Helpful further information (optional)

Please tell us why you gave your answer

What could we do to improve your experience?

Question	Yes	No
Were you treated with dignity and respect?	Yes	No
Did staff explains things in a way that you could understand?	Yes	No

How easy was it to access our service?

Very easy

Fairly easy

Neither easy nor difficult

Difficult

Very difficult

What did we do well?

What could we do better?

A bit more about you (optional)

Your name

Your email address

Name of patient (if not you)

What is your age?

Please Select An Option 16-2021-3031-4041-5051-6061-6465 & overRather not say

How would you describe your gender?

Please Select An Option MaleFemaleTransgender IntersexRather not say

What is your ethnic background?

Please Select An Option White BritishWhite IrishWhite OtherBlack CaribbeanBlack AfricanBlack OtherIndianPakistaniBangladeshiAsian OtherWhite & Black CaribbeanWhite & Black AfricanWhite & AsianMixed OtherChineseAny Other

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