A&E Services Feedback
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1. What was the date/time when you used the A&E service?

What was the date/time when you used the A&E service?

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2. How did you get to A&E eg. Ambulance, taxi, own vehicle?

How did you get to A&E eg. Ambulance, taxi, own vehicle?

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3. Which A&E Department did you attend eg. UHNS, Wolverhampton.

Which A&E Department did you attend eg. UHNS, Wolverhampton.

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4. How long did it take for you to get to the A&E Department?

How long did it take for you to get to the A&E Department?

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5. How would you rate the quality of the service you received at the A&E Department? eg. waiting times, cleanliness, triage, pain management, treatment, admission, discharge, getting home again?

How would you rate the quality of the service you received at the A&E Department? eg. waiting times, cleanliness, triage, pain management, treatment, admission, discharge, getting home again? Very poor

Poor

Good

Very good

Excellent

Other comments (please specify)

6. What was the impact on you/your relatives or carers? eg. travelling, visiting, arranging community services and discharge.

What was the impact on you/your relatives or carers? eg. travelling, visiting, arranging community services and discharge.

7. Did you encounter any problems you would like to tell us about?

Did you encounter any problems you would like to tell us about?

8. What were the positives of the services you received from the A&E Department?

What were the positives of the services you received from the A&E Department?

9. Is there anything else about your own experience that you would like to share with us?

Is there anything else about your own experience that you would like to share with us?

10. Please confirm your age range and district of Staffordshire/other in which you reside:

Please confirm your age range and district of Staffordshire/other in which you reside: 16-24

25-40

41-55

56-65

65+

District of Staffordshire/other

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A&E Services FeedbackExit this survey

*1. What was the date/time when you used the A&E service?

*2. How did you get to A&E eg. Ambulance, taxi, own vehicle?

*3. Which A&E Department did you attend eg. UHNS, Wolverhampton.

*4. How long did it take for you to get to the A&E Department?

*5. How would you rate the quality of the service you received at the A&E Department? eg. waiting times, cleanliness, triage, pain management, treatment, admission, discharge, getting home again?