Sexual Health Clinic Survey

[Clinic Logo]

[Whittall Street] clinic survey

What is this survey about?

This survey is about the care you have received in the clinic on your visit today. It should take no longer than 10 minutes to complete. Your feedback is important to us to help improve services at the clinic.

. Completion of this questionnaire is voluntary

If you choose not to take part in this survey it will not affect the care you receive from the NHS in any way. If you do not wish to take part or you do not want to answer some of the questions, you do not have to give us a reason.

Your answers will be treated in complete confidence and all responses will be completely anonymous. Please do not write your name or address anywhere on this questionnaire.

Completing the questionnaire

Please answer these questions about your visit to the clinic today
For each question please tick clearly inside one box.
Sometimes you will find the box you have ticked has an instruction to go to another question. By following the instructions carefully you will miss out questions that do not apply to you.
If you make a mistake please cross it out and put a tick in the correct box.
Answer the questions after your clinic appointment and leave the completed survey in the box provided in the reception area.
If you wish to take the survey home to complete please post in the pre paid envelope.
If you have any questions about filling in the survey please contact a member of the clinic staff or [XXXXXXX]on [XXX XXX XXXX]

A.BEFORE YOUR APPOINTMENT

1. How many times have you been to this clinic before?

1 This is my first timeGo to Q2

2 This is my 2nd timeGo to Q3

3 More than twice Go to Q3

2. Was the clinic easy to find today?

1 Yes, definitely

2 Yes, to some extent

3 No

3. Was the reception area welcoming and friendly when you arrived at the clinic today?

1 Yes, definitely

2 Yes, to some extent

3 No

4. Were the reception staff friendly and approachable?

1 Yes, definitely

2 Yes, to some extent

3 No

5. Was the booking-in process at reception today organised and easy to follow?

1 Yes, definitely

2 Yes, to some extent

3 No

6.Before you attended the clinic today, did you know what would happen during the appointment?

1 Yes, definitely

2 Yes, to some extent

3 No

B. WAITING FOR YOUR APPOINTMENT

7.Did you make an appointment to come to the clinic today or did you just turn up?

1 Made an appointment before comingGo to Q7a

2 Just turned up / walk-in patient Go to Q10

7a. Was the time and date of your pre-booked appointment convenient for you?

1 Yes, definitely

2 Yes, to some extent

3 No

8. How long after your stated appointment time was it until you were you seen by a doctor or nurse?

1 Seen on time, or early Go to Q11

2 Waited up to 5 mins Go to Q11

3 Waited 6 - 15 mins Go to Q9

4 Waited 16 - 30 mins Go to Q9

5 Waited more than 30 mins Go to Q9

6 Don’t know/Can’t remember Go to Q9

7 I arrived late for my appointment Go to Q9

9. Were you told how long you would have to wait to be seen?

1 YesGo to Q11

2 No, but I would have liked to have been toldGo to Q11

3 No, but I did not mindGo to Q11

PATIENTS WITHOUT AN APPOINTMENT

10. When you arrived at the clinic were you awarehow long you would have to wait to be seen by a doctor or nurse?

1 Yes, but the wait was shorter

2 Yes, and I had to wait about as long as I was told

3 Yes, but the wait was longer

4 No, I was not told

5 Don’t know / Can’t remember

ALL PATIENTS

11. Was there enough to do while you were waiting?

1 Yes, definitely

2 Yes, to some extent

3 No

C. ABOUT THE CLINIC

12a. In your opinion, how clean was the clinic?

1 Very clean

2 Fairly clean

3 Not very clean

4 Not at all clean

5 Did not notice

12b. In your opinion, how clean were the toilets at the clinic?

1 Very clean

2 Fairly clean

3 Not very clean

4 Not at all clean

5 I did not use a toilet

D. DURING YOUR APPOINTMENT

Seeing a Doctor / Consultant

13. Did you see a doctor / consultant during today’s appointment?

1 Yes Go to Q14

2 NoGo to Q19

14. Was the doctor / consultant you saw friendly and approachable?

1 Yes, definitely

2 Yes, to some extent

3 No

15. Did the doctor / consultant explain the reasons for any treatment or action in a way that you could understand?

1 Yes, completely

2 Yes, to some extent

3 No

4 I did not need an explanation

5 No treatment or action was needed

16. Did the doctor / consultantlisten to what you had to say?

1 Yes, definitely

2 Yes, to some extent

3 No

17. If you had important questions to ask the doctor / consultant, did you get answers that you could understand?

1 Yes, definitely

2 Yes, to some extent

3 No

4 I did not need to ask

5 I did not have an opportunity to ask

18. Did you have confidence and trust in the doctor/consultant that you saw today?

1 Yes, definitely

2 Yes, to some extent

3 No

Seeing a nurse

19. Did you see a nurse during today’s appointment?

1 Yes Go to Q20

2 NoGo to Q25

20. Was the nurse you saw friendly and approachable?

1 Yes, definitely

2 Yes, to some extent

3 No

21. Did the nurse explain the reasons for any treatment or action in a way that you could understand?

1 Yes, completely

2 Yes, to some extent

3 No

4 I did not need an explanation

5 No treatment or action was needed

22. Did the nurse listen to what you had to say?

1 Yes, definitely

2 Yes, to some extent

3 No

23. If you had important questions to ask the nurse, did you get answers that you could understand?

1 Yes, definitely

2 Yes, to some extent

3 No

4 I did not need to ask

5 I did not have an opportunity to ask

24. Did you have confidence and trust in the nurse examining and treating you?

1 Yes, definitely

2 Yes, to some extent

3 No

E.TESTS

25. Did you have any tests (such as swabs, urine samples or blood tests) when you visited the clinic today?

1 YesGo to Q25a

2 NoGo to Q26

25a. Did a member of staff explain which test(s) were being taken in a way you could understand?

1 Yes, completely

2 Yes, to some extent

3 No

4 It was not necessary

5 Don’t know / Can’t remember

25b.Did a member of staff explain what the test(s) were for in a way you could understand?

1 Yes, completely

2 Yes, to some extent

3 No

4 It was not necessary

5 Don’t know / Can’t remember

25c.Were you told clearly how you would find out the results of your tests?

1 Yes, definitely

2 Yes, to some extent

3 No

4 I received my results during my visit to the clinic

5  Don’t know / Can’t remember

F. OVERALL ABOUT THE APPOINTMENT

26. What was the total amount of time you spent in the clinic today?

1 Less than 10 minutes

2 10 – 20 minutes

3 21 – 30 minutes

4 Between 30 minutes and 1 hour

5 60-90 minutes

6 Over 90 minutes

27. Was this total amount of time spent in the clinic todayacceptable to you?

1 Yes, definitelyGo to Q29

2 Yes, to some extent Go to Q28

3 NoGo to Q28

28.If not, please state why not?

29. Did you feel that your personal information was kept confidential in each of the following areas: (please answer sections a, b and c):

a) Reception area?

1 Yes, definitely

2 Yes, to some extent

3 No

b) The waiting area?

1 Yes, definitely

2 Yes, to some extent

3 No

c) The consulting rooms/treatment areas?

1 Yes, definitely

2 Yes, to some extent

3 No

30. Were you given enough privacy when discussing your condition or treatment?

1 Yes, definitely

2 Yes, to some extent

3 No

31. Were you given enough privacy when being examined or treated?

1 Yes, definitely

2 Yes, to some extent

3 No

4 I was not examined or treated

32. Did doctors and/or other staff talk in front of you as if you weren’t there?

1 Yes, definitely

2 Yes, to some extent

3 No

33. Sometimes one member of staff will tell you one thing and another will tell you something different. Did this happen to you?

1 Yes, definitelyGo to Q34

2 Yes, to some extent Go to Q34

3 No Go to Q35

34If yes, please give details below

G. AFTER SEEING THE DOCTOR OR NURSE

Information

35. Were you offered any written or printed information about your condition or treatment?

1 Yes, and I took it Go to Q35a

2 Yes, but I did not take it Go to Q36

3 No, but I would have liked it Go to Q36

4 No, but I did not need itGo to Q36

5 No, but I knew where to find it if I needed itGo to Q36

35a. Was this information clear and easy to understand?

1 Yes, definitely

2 Yes, to some extent

3 No

4 I have not yet read the information

Medications (eg. medicines, tablets, ointments)

36. Before you left clinic were you given any new medications (medications that you had not had before)?

1 YesGo to Q36a

2 NoGo to Q37

36a. Did a member of staff explain to you how to take the new medications?

1 Yes, completely

2 Yes, to some extent

3 No

4 I did not need an explanation

36b. Did a member of staff tell you about medication side effects to watch for?

1 Yes, completely

2 Yes, to some extent

3 No

4 I did not need this type of information

H. OVERALL IMPRESSION

37. Was the main reason you went to the clinic today dealt with to your satisfaction?

1 Yes, completely

2 Yes, to some extent

3 No

38. Overall, did you feel you were treated with respect and dignity while you were at the clinic?

1 Yes, all of the time

2 Yes, some of the time

3 No

39. Would you attend the clinic again if you needed to?

1 Yes, definitely

2 Yes, probably

3 No

40. Would you recommend the clinic to a friend?

1 Yes, definitely

2 Yes, probably

3 No

41. Overall, how would you rate the care you received at the clinic today?

1 Excellent

2 Very good

3 Good

4 Fair

5 Poor

6 Very poor

I. ABOUT YOU

42. Are you male or female?

1 Male

2 Female

43. How old are you?

44. What was the main reason for attending the clinic today? Please tick one box only

1Concern about symptoms

2Check-up

3Follow-up appointment

4To get test results

5Other (please specify)

45. What language do you speak most often at home? Please tick one box only

1English

2Other European language

3Asian language (such as Hindi, Gujarati, Punjabi, Urdu, Sylheti, Bengali, Chinese, Thai)

4African language (such as Swahili, Hausa, Yoruba)

5Other, including British Sign Language.

46. Are your sexual partners:

1 Men

2 Women

3 Both men and women

4 Prefer not to say

47. To which of these ethnic groups do you belong?

a. WHITE

1 British

2 Irish

3 Any other white background

b. MIXED

4 White and Black Caribbean

5 White and Black African

6 White and Asian

7 Any other mixed background

c. ASIAN OR ASIAN BRITISH

8 Indian

9 Pakistani

10Bangladeshi

11Any other Asian background

d. BLACK OR BLACK BRITISH

12 Caribbean

13 African

14 Any other black background

e. CHINESE OR OTHER ETHNIC GROUP

15 Chinese

16 Any other ethnic group

48. Did you need any help to complete this questionnaire today (e.g. from an interpreter or member of clinic staff?

1 Yes

2 No

ANY OTHER COMMENTS

If there is anything else you would like to tell us about your experiences in the clinic, please do so here.

Was there anything particularly good about your visit to the clinic today?
Was there anything that could have been improved?
Please list below the numbers of any questions in this survey which you found unclear and the reasons for this.

Thank you for completing the survey

Please check you have completed all the questions

Please place the questionnaire [in the box provided in reception or post with the prepaid envelope by XXth XXXX. No stamp is needed]