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Milton Keynes Council Service User Questionnaire Wheelchair Assessment Service Milton Keynes Council checks services to make sure they are good quality and give you what you need. Please tell us what you think about the service you use by answering the questions. When you have answered the questions please give it to the service manager. If you need any help with the form or want to speak to someone in person, please contact Andrea Bushell via the Joint Commissioning Team on 01908 252453. [email protected] Yes No Don’ t Know 1. Accessing the service (Please below) a. Was your referral to the service prior to December 2013? b. Did you have any problems accessing the service? (Please tell us here) _____________________________________ __ _____________________________________ __ _____________________________________ __ Page 1 of 10
Transcript of Milton Keynes Councilbtckstorage.blob.core.windows.net/site4667/Easy Read... · Web viewWheelchair...
Milton Keynes CouncilService User Questionnaire
Wheelchair Assessment Service
Milton Keynes Council checks services to make sure they are good quality and give you what you need.
Please tell us what you think about the service you use by answering the questions. When you have answered the questions please give it to the service manager.
If you need any help with the form or want to speak to someone in person, please contact Andrea Bushell via the Joint Commissioning Team on 01908 [email protected]
Yes No Don’t
Know1. Accessing the service (Please below)
a. Was your referral to the service prior to December 2013?
b. Did you have any problems accessing the service? (Please tell us here)
_____________________________________________________________________________________________________________________
c. Is the referral process clear?(If no, please tell us here)_____________________________________________________________________________________________________________________
d. Was the time of your appointment good for you? (If no, please tell us here)
_____________________________________________________________________________________________________________________
Page 1 of 7
Yes
No
Don’t know
e. Were you offered an appointment at the clinic?Did you go to an appointment at the clinic?
f. Were you offered a home visit?Did the service visit you at home?
g. Did you feel the service listened to you? (Please tell us here)
_____________________________________________________________________________________________________________________
2. Communication (Please below)a. Were you contacted about your assessment appointment by:
Telephone Letter
Other: _______________________________b. Were you asked about your needs?
(Please tell us here)_____________________________________________________________________________________________________________________
c. Did they look after your needs when you:a) went to your assessment appointment? (Please tell us here)
_____________________________________________________________________________________________________________________
b) contacted the service?(Please tell us here)
_____________________________________________________________________________________________________________________
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Yes No Don’t
Knowd. After your assessment, were you told:
a) the result of the assessment
b) what happens next
c) how long it will take
e. If you needed a repair who would you contact?
a) Wheelchair Assessment Service
b) Millbrook
c) Other Health Professional
Who? ______________________________
Yes No Don’t
Know3. Personal (Please below)
a. Do you feel staff were polite and treated you with respect and dignity?
(If no, please tell us here)_____________________________________________________________________________________________________________________
b. Do you feel listened to?
c. Were you involved in planning your own treatment?
d. Has your wheelchair helped you to:a) Manage a health condition you have had for
a long timeb) Keep your independence
c) Get your independence back
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Yes No Don’t
Know4. Compliments and Complaints (Please below)
a. Do you know how to make a complaint?
b. Would you feel comfortable making a complaint about the service or the staff?
c. Do you think your concerns would be dealt with properly by the service?
If not, why? Please write your answer in the space below.____________________________________________________________________________________________________________________________________________________
d. Are you a member of a local users’ support group?
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Any Other CommentsIf there is anything else you would like to tell us about the service you, your friend or family member gets please use the space below:
Thank you for taking the time to answer our questions
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Please tell us about you
Name (you do not have to tell us)___________________________________
Your age (please a box): 18 – 25 26 – 35 36 - 45 46 - 55 56 - 65 66 or over
Are you male or female? (please a box): Male Female
How do you describe your ethnicity? (please a box):Asian or Asian British
Bangladeshi Indian Pakistani Any other Asian background
Black or Black British African Caribbean Any other Black background
Mixed Mixed ethnicity
White British Irish European Any other White background
Other Ethnic Group Chinese Any other ethnic group I don’t want to say
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Religion (please a box): Buddhist Christian Hindu Jewish Muslim Sikh No religion Other, please say
_____________________
Do you have a disability (you do not have to tell us)?_________________________
Did someone help you to fill out this form? (please a box): Yes No
Thank you for taking the time to answer our questions
It would be very helpful if we could use your comments in our reports, if you are happy with this please sign below. We will make sure your name is not used in the report.
Signed: _________________________________
Date: _________________________________
Name: _________________________________
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