Breast Screening Feedback Survey

Consent for storing submitted data *

Yes, I give permission to store and process my data No, I don't consent to storing and processing my data

How was your experience? * Thinking about your visit overall, how was your experience of our service?

Very good Good Neither poor nor poor Poor Very poor

Were you happy with the location of your appointment?

Very happy Fairly happy Not happy

If not happy, tell us why

Did you find the appointment letter easy to understand? Tick as many as you wish

Yes Well explained Confusing Didn't read it

Did you feel you were treated with respect? Overall, did you feel you were treated with respect and dignity during your visit?

Yes, all of the time Yes, some of the time No

Was your procedure explained? Did the person taking your x-ray explain the procedure to you before it took place?

Yes No

Please describe how the X-Ray felt? (Please tick one option)

Completely painless Slightly uncomfortable Uncomfortable Painful

Were you told when you would receive the results?

Yes No Not sure

What is your opinion of the staff during your visit? Tick as many answers as you wish

Friendly Caring Helpful Professional Inconsiderate Abrupt Rushed Other

Other, please specify:

Do you feel that if you had any special needs, they were met?

Yes No

If no, tell us why:

Why did you attend your appointment? What prompted your decision to attend your breast screening appointment? Choose as many reasons as you like

Benefits of Screening Personal Experience Doctor/Nurse Peace of mind Invitation letter Reading the information leaflet Location Friend/Family influence

When would you prefer to attend a breast screening appointment?

Mon—Fri between 9:00am—4:30pm Saturday between 9am—12 noon Mon—Fri evening 5:00pm-8:00pm Saturday 1:00pm-5:00pm

What did we do well today?

What could we do better?

Please select your age

49-64 65-70 71+

Do you have of the following long term conditions? e.g. asthma/COPD/cancer/HIV/Diabetes/Chronic heart disease/epilepsy

Deafness or severe hearing impairment A long standing physical condition A mental health condition Dementia Blind or partially sighted A learning disability A long-standing illness I do not have a long standing condition

What is your ethnic group?

White British White European Mixed multi ethnic groups Black African/Caribbean/Black British Asian or Asian British Other ethnic group Prefer not to say

Staff feedback If there was a particular member of staff who deserves a special mention, please tell us their name

What did they do to make them deserve a special mention?