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Lung Cancer Screening Programme
LCS Mobile CT scanner feedback form
LCS Mobile CT scanner feedback form
LCS Mobile CT scanner feedback form
Consent for storing submitted data
Yes, I give permission to store and process my data
Were you satisfied with your visit to the mobile CT scanner
Completely Satisfied
Satisfied
Not satisfied
If you were not satisfied with your visit please indicate why
What day did you attend the mobile CT scanner?
Time of day?
Did you need to change your CT scan appointment time?
Yes
No
What age group are you?
55-60
61-65
66-70
71-74
Are you satisfied with the lung cancer screening programme?
Yes
No
If you are not satisfied with the lung cancer screening service, please indicate why?
Do you have any other comments about the lung cancer screening programme?
