WaMH in PC Managing Dementia in Primary Care - Questionnaire

Questionnaire Part 1

The Questionnaire needs to be completed by the Facilitator / Dementia Lead on behalf of the surgery. (The person is filling in the whole form with the exception of a few questions that they may need to ask someone to give them the answers to).

Questions 1 - 11 will provide WaMH in PC with background information on your surgery and gather information on the relevance of the training to your practice.

Comment boxes are provided for any additional comments you would like to include, which have relevance to the training.

Question Title

* 1. Please provide your name and title

Name

Title

Question Title

* 2. Name of your surgery

Question Title

* 3. Which Health Board(s) do you work in?

Abertawe Bro Morgannwg Health Board

Aneurin Bevan Health Board

Betsi Cadwaladr Health Board

Cardiff and Vale University Health Board

Cwm Taf Health Board

Hywel Dda Health Board

Powys Teaching Health Board

Question Title

* 4. When did the surgery complete the 'Managing Dementia in Primary Care' training

Date

WaMH in PC Managing Dementia in Primary Care - Questionnaire

Questionnaire Part 1

Question Title

* 1. Please provide your name and title

Question Title

* 2. Name of your surgery

Question Title

* 3. Which Health Board(s) do you work in?

Question Title

* 4. When did the surgery complete the 'Managing Dementia in Primary Care' training

Question Title

* 5. How many people work in your practice team?

Question Title

* 6. How many members of staff completed the training, excluding, the Advance Care Planning and End of Life Care module?

Question Title

* 7. How many members of staff completed the Advance Care Planning and End of Life Care module?