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Diabetes patient survey

Diabetes Patient Survey

I am:
Q1) How satisfied or dissatisfied were you with your healthcare practitioner addressing your diabetes needs?
Q2) How satisfied or dissatisfied were you with the healthcare practitioner in making you feel at ease during your appointment?
Q3) How satisfied or dissatisfied were you with the care you received in relation to your diabetes?
Q4) How satisfied or dissatisfied were/are you with your diabetes management plan?
Q5) Overall, how satisfied or dissatisfied were you with your experience of our diabetes service?

Getting feedback from all communities (optional)

This information will be held in confidence and will not be attributed to any individual.

We collect this information to ensure that we are meeting the needs of all communities.

We are obliged to share some information with other agencies, for example our commissioners (the NHS and other organisations that commission us to provide services) and the Care Quality Commission.

You may find that some of the questions are not relevant to you. If you feel comfortable providing some or all of the information below please answer the appropriate questions.

(First part only)
Gender:
What is your ethnic group?
White:
Mixed or multiple ethnic groups:
Asian/Asian British:
Black/African/Caribbean/Black British:
Age:
Do you have any long-term illness, health problems or disability (include problems which are due to old age)?
Please indicate which of the following condition(s) apply:
Sexual orientation:
What is your religion or belief?