Carers Survey

How would you rate your family/friend/service user's appointment today, based on the attitude and helpfulness of the reception staff? *

	1	2	3	4	5

1 is Poor, 5 is Excellent

How would you rate you family/friend/service user's appointment today, based on the clinic environment and accessibility? *

	1	2	3	4	5

1 is Poor, 5 is Excellent

How would you rate your family/friend/service user's appointment today, based on the waiting time for your patients appointment? *

	1	2	3	4	5

1 is Poor, 5 is Excellent

How would you rate your family/friend/service user's appointment today, based on how well the clinician listened to you and/or your patient? *

	1	2	3	4	5

1 is Poor, 5 is Excellent

How would you rate your family/friend/service user's appointment today, based on how well the clinician explained the patients treatment *

	1	2	3	4	5

1 is Poor, 5 is Excellent

Overall, how was your experience with Community Eyecare? *

Very Good Good Satisfactory Poor Very Poor Unsure

Would you like to share any further comments about your patient experience?

Are there any changes that you think would improve the service for carers?

Please let us know of any areas of dissatisfaction so that we can act on this and make improvements to the service we offer

Which clinic did you attend? *

We would like to be able to include anonymous comments from our patients and carers in our marketing communications. Would you be happy for Community Eyecare to use your comments in this way? *

Yes No