CHI Experience of Service Questionnaire

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EXPERIENCE OF SERVICE QUESTIONNAIRE

Day services (Parent or Carer)

Please think about the appointments you, your child and/or your family have had at this service or clinic.

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

Parent or Carer

I feel that the people who have seen my child listened to me

Certainly True

Partly True

Not True

Don't Know

It was easy to talk to the people who have seen my child

Certainly True

Partly True

Not True

Don't Know

I was treated well by the people who have seen my child

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 with the problem I came for

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 my child are working together to help with the problem(s)

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

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

Certainly True

Partly True

Not True

Don't Know

It is quite easy to get to the place where the appointments are

Certainly True

Partly True

Not True

Don't Know

If a friend needed similar help, I would recommend that he or she 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?

Child's age

Child's gender

Female

Male

Child's ethnicity

White

Black or Black British

Asian or Asian British

Mixed

Other

Is your child registered disabled (e.g. hearing impaired)?

Yes

THANK YOU FOR YOUR HELP