Girling Street Feedback Centre 2020

About you

Name

Leave feedback anonymously?

Email* (Your email will be kept private and you will not be sent any marketing material)

I accept the Terms and conditions

I consent to being contacted regarding my feedback by Healthwatch*

Yes No

I confirm I am over the age of 16*

Yes No

I have parental consent*

Yes No

If you are willing to provide us with some monitoring information please click here.

Please note: Monitoring information helps us identify trends and gaps in our information gathering, enabling us to provide more detailed evidence to service providers and commissioners about your health and social care services.

Please tell us your age

How would you describe your gender?

What is your ethnicity?

Do you have a disability?

If you would prefer to self-describe your gender, please use the box below.

Do you have a long-term condition?

Only your overall rating, comment and name (if disclosed) will be visible online.

Leave your feedback

Leave your Feedback

How do you rate your overall experience of this service?*

Summary of your experience* (max 45 characters)

Tell us more about your experience*

Where do you live? (town/city)

Your ratings (select if applicable)

Staff Attitude

Quality of care

What could have helped to improve your experience of this service?

In relation to your comments are you a:

How did you hear about us?

When did this happen?

Do you want to know more about how to make an official complaint?*

No Yes