CHI Experience of Service Questionnaire

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EXPERIENCE OF SERVICE QUESTIONNAIRE

Day services (9-11)

What do you think about coming to this service or clinic.

For each item, please circle the answer that is closest to what you think

Ages 9 to 11

Did the people who saw you listen to you?

Yes

Only a little

Not really

Don't Know

Was it easy to talk to the people who saw you?

Yes

Only a little

Not really

Don't Know

How were you treated by the people who saw you?

Very well

Not very well

Don't Know

Were your views and worries were taken seriously?

Yes

Only a little

Not really

Don't Know

Do you feel that the people here know how to help you?

Yes

Only a little

Not really

Don't Know

Were you given enough explanation about the help available here?

Yes

Only a little

Not really

Don't Know

Do you feel that the people here are working together to help you?

Yes

Only a little

Not really

Don't Know

The facilities here (like the waiting area) are

Comfortable

Uncomfortable

Don't Know

The time of my appointments was

Convenient

Not convenient

Don't Know

The place where I had my appointments was

Easy to get to

Ok to get to

Hard to get to

Don't Know

If a friend needed this sort of help, do you think they should come here?

Yes

Maybe

Not really

Don't Know

Has the help you got here been good?

Yes

Only a little

Not really

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 a

Girl

Boy

I consider myself

White

Black or Black British

Asian or Asian British

Mixed

Other

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

Yes

THANKS FOR HELPING US