Please help us to improve our service by answering some questions about the service you have received. We are interested in your honest opinions, whether they are positive or negative. Please answer all of the questions. We also welcome your comments and suggestions. Please select one option from each of the following questions:

    1. Did staff listen to you and treat your concerns seriously?
    All of the timeMost of the timeSometimesRarelyNever

    2. Do you feel that the service has helped you to better understand and address your difficulties?
    All of the timeMost of the timeSometimesRarelyNever

    3. Did you feel involved in making choices about your treatment and care?
    All of the timeMost of the timeSometimesRarelyNever

    4. On reflection, did you get the help that mattered to you?
    All of the timeMost of the timeSometimesRarelyNever

    5. Did you have confidence in your therapist and her / his skills and techniques?
    All of the timeMost of the timeSometimesRarelyNever

    Please tell us about your experience of our service. We do appreciate your help and thank you very much for your comments.

    Your Full Name

    Email

    Contact Telephone Number

    Date of Birth

    My GP Surgery is in:

    Questionnaires submitted from this page are monitored during normal office hours Monday to Friday (except bank holidays) and this form should not be used in an emergency. If you are feeling at risk to yourself or others please contact your GP urgently or you can dial the NHS 111 helpline for further advice on what to do at this time. Alternatively you can telephone the Samaritans 24 hours a day on 116 123.