Go Questionnaire (RSG)

The Ready Steady Go transition programme

The medical and nursing team aim to support you as you get older and help you gradually develop the confidence and skills to take charge of your own healthcare.

Filling in this questionnaire will help the team create a programme to suit you. Please answer all questions that are relevant to you and ask if you are unsure.

Email of your Doctor/Nurse/Healthcare professional*

This will be used to send a copy of your questionnaire straight to your doctor. If you do not have your doctors email address, use your own here and you will then receive a copy of the completed form to print out to take to your appointment

Name of your Consultant (if known)

Your Name

Date

Knowledge

	Yes	I would like some help/advice with this	Comments
I am confident in my knowledge about my condition and its management
I understand what is likely to happen with my condition when I am an adult
I look after my own medications
I can order and collect my repeat prescriptions and book my own appointments
I call the hospital myself if there is a query about my condition and/or therapy

Self Advocacy (Speaking up for yourself

	Yes	I would like some help/advice with this	Comments
I feel confident to be seen on my own in clinic
I understand my right to confidentiality
I understand my role in shared decision making with the healthcare team e.g Ask 3 Questions

Health and Lifestyle

	Yes	I would like some help/advice with this	Comments
I exercise regularly/have an active lifestyle
I understand the risks of drugs, alcohol and smoking to my health
I understand what appropriate eating means for my general health
I know where and how I can access reliable information about sexual health
I understand the implications of my condition and medications on pregnancy/parenting (if applicable)

Daily Living

	Yes	I would like some help/advice with this	Comments
I can look after myself at home in terms of dressing/showering, preparing meals etc
I can or am learning to drive
I know how to plan ahead for being away from home, overseas, trips e.g storage of medications and vaccinations
I understand my eligibility for benefits (if applicable)

Education and Your Future

	Yes	I would like some help/advice with this	Comments
I have had work/volunteering experience
I am aware of any potential impact (if any) of my condition to my education and/or work opportunities
I know how and what to tell a potential employer about my condition (if applicable)
I have a career plan (please specify)
I know who to contact for careers advice

Leisure

	Yes	I would like some help/advice with this	Comments
I can use public transport and access my local community e.g shops, leisure centre, cinema
I see my friends outside school/college/work

Managing your Emotions

	Yes	I would like some help/advice with this	Comments
I know how to deal with unwelcome comments/bullying
I know someone I can talk to when I feel sad/fed-up
I know how to deal with emotions such as anger or anxiety
I am comfortable with the way I look
I am happy with life
I know where I can get help to deal with my emotions if needed

Transfer to Adult Care

	Yes	I would like some help/advice with this	Comments
I understand the meaning of 'transition' and transfer of information about me
I am aware of the plan for my medical care when I am an adult
I have all the information I need about the adult team who will be looking after me

Please list anything else you would like help or advice with

The Ready Steady Go transition programme - Go