Friends and Family Test Survey

Introduction

Your opinion and experience of our services is important to us. Please help us to understand and improve your experience of care as a patient or carer by completing this short survey questionnaire. It is free, anonymous and will only take a few minutes of your time. Thank you.

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* 1. Please enter department or ward

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* 2. Hospital site

Maidstone Hospital

Tunbridge Wells Hospital

Other (please specify)

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* 3. Please select the date of your visit

Date

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* 4. Completed by

Patient

Patient's relative

Carer

Other (please specify)

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* 5. Overall, how was your experience of our service?

Very good

Good

Neither good nor poor

Poor

Very poor

Don't know

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* 6. Please can you tell us why you gave your answer and what we could have done better?

Demographics

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* 7. Gender

Male

Female

Non Binary

Trans Man

Trans Woman

Prefer not to say

Other

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* 8. What age are you?

0-15

16-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

Prefer not to say

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* 9. What is your ethnic group?

White

Mixed or multiple ethnic groups

Asian or Asian British

Black, Black British, Caribbean or African

Other ethnic group

Prefer not to say

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* 10. Do you have any of the following conditions?

A long-standing physical condition

A mental health condition

A learning disability

A long-standing illness (e.g. asthma, diabetes, COPD, cancer, dementia, heart disease)

Blind or partially sighted

Deafness or severe hearing impairment

None of the above

Other (please specify)

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* 11. We would like to be able to include actual anonymous comments from our patients in our promotional material. Would you be happy for your comments to be used in this way?

Yes

Thank you for completing this survey