* 1. How did you find out about our services?

* 2. Which clinic did you attend?

* 3. In which area?

* 4. I was made feel welcome at the clinic

* 5. A member of staff at the clinic told me what and how things would happen at the clinic.

* 6. My privacy and confidentiality was respected at all times by the clinic staff.

* 7. Do you think the amount of information you received at the clinic about your condition and treatment was:

* 8. The information I received at the clinic was given to me in a way I could understand.

* 9. Do you feel your needs and expectations were met whilst at the clinic?

* 10. If you feel your needs and expectations were not fully met can you explain below?

* 11. What do you think works well at the clinic?

* 12. What do you think could be done better at the clinic?

* 13. Overall, is there anything the staff at the clinic could do to improve Sexual Health Services for people in NHS Forth Valley?

Thank you for taking the time to complete this questionnaire. We will use your feedback to continually assess the quality of our services.
This questionnaire is totally confidential and unless you wish to participate in the user group there is no need to provide your name and contact details.

User Group
Hearing about the experience of people who have attended sexual health clinics and listening to their thoughts and opinions is important to us, it helps us to continually develop services for the future.

We plan to hold user group meetings twice a year to allow users of the service to have a voice in influencing future service developments.

If you are interested in getting involved in the user group please provide details below of how we can contact you:

Or contact us by e mail atFV-UHB-sexualhealth@nhs.net

* 14. Contact details

* 15. Confidentiality and Data Protection Policy
Use of the Internet, Confidentiality and Data Protection Statement
Your information is transmitted to us electronically in a non-secure way. As with any non-secure electronic communication, there is a chance that your information may be intercepted and viewed by someone else.

Unfortunately we cannot accept any responsibility for any damages or loss whatsoever caused by the interception of your personal information.

The contact details you provide will be retained in the files of the Central Sexual Health Service, Falkirk Community Hospital, Major's Loan, Falkirk FK1 5QE. We will only use this information to contact you regarding participation in a user group.

The information you provide on this form will be treated as confidential, and will not be shared with any other parties.

I confirm that I have read and agreed to the Confidentiality and Data Protection Policy.