MHP Outreach -Patient Survey

Question Title

* 1. How likely are you to recommend our service to friends and family if they needed similar care or treatment?

Extremely Likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Question Title

* 2. What service would you have used if the outreach service wasn't available ?

111 for advice

Walk in Centre

Urgent Care Centre

A&E setting

Community Pharmacy

Prefer not to say

Question Title

* 3. Where did you hear about this service ?

NHS 111

Outreach Leaflet

Word of mouth/ Family & Friends

Other Homelsss service

Other

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* 4. What gender are you?

Male

Female

Transgender

Prefer not to say

Question Title

* 5. What age group are you in?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 6. Which race/ethnicity best describes you? (Please choose only one.)

English/ Welsh/ Scottish/ Northern Irish/ British

Irish

Travelling Community

Any other white background

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed / multiple ethnic background

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background

African

Caribbean

Any other Black / African/ Caribbean background

Arab

Any other ethnic group

Multiple ethnicity / Other (please specify)

MHP Outreach -Patient Survey

Question Title

* 1. How likely are you to recommend our service to friends and family if they needed similar care or treatment?

Question Title

* 2. What service would you have used if the outreach service wasn't available ?

Question Title

* 3. Where did you hear about this service ?

Question Title

* 4. What gender are you?

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* 5. What age group are you in?

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* 6. Which race/ethnicity best describes you? (Please choose only one.)

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* 7. Please share any other comments you have below: