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HRS Closure Impact Survey
1.
What is your age?
18-25
26-45
46-65
66-85
Over 85
Prefer not to say
2.
Are you an unpaid carer?
Yes
No
Prefer not to say
3.
Do you have a condition that impacts your day-to-day life? (such as Diabetes or Depression, or any condition that requires you to take medication every day)
Yes
No
Prefer not to say
4.
When was the last time you attended the Harold Road Site?
Last 12 months
1 - 3 years ago
Over 3 years ago
Never
5.
In the last 12 months, how many times have you attended the Harold Road Site?
Never
Once or twice
3-5 times
More than 5 times
6.
When you attended the Harold Road Site, how did you normally travel there?
Walk
Driving (myself)
Lift from a friend/neighbour/family member
Cycle
Taxi
Public Transport
I have never attended the Harold Road Site
7.
When was the last time you attended the Ore Clinic or Fairlight Road sites?
In the last week
Within the last 12 months
1 – 3 Years ago
Over 3 Years ago
Never
8.
When you attend either of these sites, how do you usually travel there?
Walk
Drive (Yourself)
Lift from a friend/neighbour/family member
Cycle
Taxi
Public Transport
N/A
9.
Do you feel the journey from the Harold Road site to the Ore Clinic site is…?
Very Easy
Easy
Neither easy nor difficult
Difficult
Very difficult
N/A
10.
How do you feel the closure of the Harold Road site would affect you? Please provide details, if applicable.
It won’t have an impact
It will have a minor impact (e.g. It will be slightly harder to attend appointments but I can cope)
It will have a significant impact (e.g. I will have to change GP)
More details (if it will impact you):
11.
Do you have any concerns about the closure of Harold Road site? (Please select all that apply)
Transport
Opening Hours
Dispensary
Reduced services
Other