FFT Trust Website

Our Friends and Family Test

	What type of service have you accessed?

	Which children and young peoples service did you access? (including wards)

	Which adult service have you accessed ? (including wards)

	Which older people's service have you accessed? (including wards)

	Which learning disability service have you accessed?

	Which drug and alcohol service have you accessed ?

	If you cant find the service you accessed on the drop down list please use the space below to tell us who you saw.

Overall how was your experience of our service?
Very good	Good	Neither good nor poor	Poor	Very poor	Don't know
Very good	Good	Neither good nor poor	Poor	Very poor	Don't know

	Please can you tell us anything which you thought we did well or any way we can improve?

	Date of Appointment

	Are you?

	If you would prefer to self identify please use the space below

	What age are you?

	What is your ethnic group?

	If other please specify

Do you consider yourself to have a physical or mental health condition or disability?

Yes

	Additional details:

Are you?

The patient

The parent or carer

The patient and parent or carer

We would like to include actual anonymous comments from our patients in our promotional material.Would you be happy for your comments to be used in this way?

Yes

Thank you for taking time to provide your feedback to improve our services.