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Waiting List Experience Survey
*
1.
Are you, your child, or a relative on a HSE waiting list, or have you been?
(Required.)
Yes - currently on a list
Yes - previously on a list
No
2.
Do you have private health insurance?
Yes
No
*
3.
What sort of list are you/your child/relative on?
(Required.)
To see a consultant
To have a procedure
An assessment of need (for disability/education services)
Other - please specify in next question
4.
Please specify specialty, condition, and procedure as appropriate
*
5.
How long have you/your child/relative been on a waiting list?
(Required.)
0-3 Months
3-6 Months
6-12 Month
12-18 Months
18+ Months
*
6.
How has the length of wait affected you/your child/your relative's condition?
(Required.)
Severe
Considerable
Moderate
A little
Not at all
*
7.
How has the length of wait affected you/your child/your relative's general and mental health?
(Required.)
Severe
Considerable
Moderate
A little
Not at all
8.
In what way has it impacted on you/your child/relative's condition, health, and wellbeing?
9.
How has this experience impacted on your family?
10.
Please tick the options which apply to you
This causes me a lot of stress or anxiety
This causes me some stress or anxiety
This has impacted negatively on my quality of life
I have considered private healthcare, but I am worried about the cost
It does not concern me
11.
Do you believe that the Government is doing enough to tackle waiting lists?
Yes
No
12.
Do you have any comment you would like to add?
13.
Demographic question - If this is about you/your child, what is your household income?
Cannot work due to condition
Under €15,000
Between €15,000 and €29,999
Between €30,000 and €49,999
Between €50,000 and €74,999
Between €75,000 and €99,999
Between €100,000 and €150,000
Over €150,000
14.
Demographic question - what is you/your child/your relative's age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
15.
Demographic question - what county are you living in?
Current Progress,
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