Your Experience Matters

Sirona provides community health services across Bristol, South Gloucestershire and North Somerset and if we have provided care for you or a member of your family, we'd love to hear your views, positive and not-so-positive. I know our success is judged by the experiences of you, your family or your friends. I would really appreciate it if you would take a moment to complete this short survey as your feedback will help us see what we are doing well and where we need to improve. Your responses will be anonymous. Thank you.

Janet Rowse - Chief Executive


If you would like it in another format such as in another language or large print please email: sirona.surveys@nhs.net.


Type of Service
Adult and Specialist Services
Children's Services
Name of Service Used:
Date Completed
Please answer the following questions
Who is completing this survey?
Carer
Friend or Family member
Service user
Other
Were you able to access the service easily?
Yes
Yes, to some extent
No
 
Did you feel welcome when using our services?
Yes
Yes, to some extent
No
 
Did we tell you about how we could help you?
Yes
Yes, to some extent
No
 
Did we communicate and share information with you in a way you could understand?
Yes
No
If no, please provide more information below
 
Did we tell you why this would help?
Yes
Yes, to some extent
No
 
Did we listen to you?
Yes
Yes, to some extent
No
 
Did we plan your care with you?
Yes
Yes, to some extent
No
 
Did we treat you kindly?
Yes
Yes, to some extent
No
 
Did our service help you or the person you care for?
Yes
Yes, to some extent
No
 
Can you look after your own health, or the person you care for, better now?
Yes
Yes, to some extent
No
 
Did we give you contact details and telephone numbers in case you need more help?
Yes
Yes, to some extent
No
 
Did you have confidence that our infection prevention control measures used by our staff would keep you safe?
Yes
Yes, to some extent
No
 
Is there anything else you want to tell us?
Please enter you comments below
Equality Questionnaire
We collect and analyse information about our service users, as it helps us to check if we are operating fairly. You do not have to answer the questions below and anything that you do tell us will be kept in strict confidence.
Please tell us about your:
ETHNICITY

White
British
Irish
Eastern European
Other White
Dual Heritage (tick all boxes that apply):
Black Caribbean
Black African
Asian
Chinese
White
Other Mixed Background
Asian or Asian British:
Indian
Pakistani
Bangladeshi
Other Asian
Black or Black British
Other Ethnic:
Chinese
Other Ethnic Category
AGE
16 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 - 74
74 - 85
85+
GENDER
Male
Female
Other
Prefer not to say
Transgender: Do you identify as transgender or do you have a transgender history? (For the purposes of this question 'transgender' is defined as an individual who lives in a gender identity that is different to their sex assigned at birth).
Yes
No
Prefer not to say
DISABILITY
Under the terms of the Equality Act 2010 a disability is defined as a 'physical or mental impairment which has a substantial and long term effect on a person's ability to carry out normal day to day activities'.

Do you consider yourself to have a disability?
Yes
No
Prefer not to say
SEXUAL ORIENTATION
Bisexual
Gay
Heterosexual
Lesbian
Prefer not to say