Dedicated Service Feedback Form

We would like to invite you to share your experience of the NHS Dedicated Service (DS) with us. All of your feedback will help us to shape the future of the service and we appreciate your time in completing this questionnaire.

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* How satisfied are you with the support you receive from your NHS DS worker (including Emotional Wellbeing support and health navigation)? (Please tick)

0 = Not satisfied

5 = Very satisfied

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* Could you tell us more about this?

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* Do you feel that your NHS DS worker has involved you in the decisions about your care? (Please tick)

0 = Not satisfied

5 = Very satisfied

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* Could you tell us more about this?

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* Has the support you received from your NHS DS worker met your needs? (Please tick)

0 = Not satisfied

5 = Very satisfied

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* Could you tell us more about this?

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* Have you been treated with dignity and respect? (Please tick)

0 = Not satisfied

5 = Very satisfied

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* Could you tell us more about this?

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* Any other comments/suggestions for the NHS DS service?

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* About you (Optional)

Name (if you would like to be contacted about your feedback)

Ethnicity

Age

Gender

Postcode

Preferred language

Please provide your contact details if you wish to be contacted to discuss your feedback

Your data will be treated in accordance with the Data Protection Act 1998 and will not be shared with any third parties. If you would prefer not to be contacted your anonymous feedback is still extremely valuable to us.

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* Thank you for taking time to complete this feedback form.

Tick to consent to the use of anonymised quotes from your feedback to promote the service

Tick if you are interested in receiving further information about service user involvement