CHI Experience of Service Questionnaire

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EXPERIENCE OF SERVICE QUESTIONNAIRE

Day services (12-18)

Please think about the appointments you have had at this service or clinic.

For each item, please tick the box that best describes what you think or feel.

Ages 12 to 18

I feel that the people who saw me listened to me

Certainly True

Partly True

Not True

Don't Know

It was easy to talk to the people who saw me

Certainly True

Partly True

Not True

Don't Know

I was treated well by the people who saw me

Certainly True

Partly True

Not True

Don't Know

My views and worries were taken seriously

Certainly True

Partly True

Not True

Don't Know

I feel the people here know how to help me

Certainly True

Partly True

Not True

Don't Know

I have been given enough explanation about the help available here

Certainly True

Partly True

Not True

Don't Know

I feel that the people who have seen me are working together to help me

Certainly True

Partly True

Not True

Don't Know

The facilities here are comfortable (e.g. waiting area)

Certainly True

Partly True

Not True

Don't Know

My appointments are usually at a convenient time (e.g. don’t interfere with school, clubs, college, work)

Certainly True

Partly True

Not True

Don't Know

It is quite easy to get to the place where I have my appointments

Certainly True

Partly True

Not True

Don't Know

If a friend needed this sort of help, I would suggest to them to come here

Certainly True

Partly True

Not True

Don't Know

Overall, the help I have received here is good

Certainly True

Partly True

Not True

Don't Know

What was really good about your care?

Was there anything you didn’t like or anything that needs improving?

Is there anything else you want to tell us about the service you received?

My age is

I am

Female

Male

I consider myself

White

Black or Black British

Asian or Asian British

Mixed

Other

Are you registered disabled (e.g. hearing impaired)?

Yes

THANK YOU FOR YOUR HELP