Your NHS Wales Experience Questionnaire

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Your NHS Wales Experience

The experience that you have of care is important to us. This might be an appointment with your doctor or health visitor, a hospital stay, an outpatient visit or something else. We would be grateful if you could complete this survey so that we can understand this better.

The questions are based on the things that patients have said matter most. We will ask you questions about your latest experience of healthcare. Please help us by giving your honest opinion.

The questions mostly have 4 options and you are asked to tick the answer that you feel best describes how you feel.

Some of the questions have ‘not applicable‘. Please tick this if the question is not relevant to your experience.

We do not need to know your personal details but have asked some general questions at the end about who you are. This is so we can make sure we are asking all groups of people about their experience.

If there is anything we have not asked you, please use the space at the end of this survey to tell us.

How recent was the experience you are thinking of?: *

Thinking about your overall first impressions of the care you received

Did you feel that you were listened to?: *

Were you able to speak in Welsh to staff if you needed to?: *

From the time you realised you needed to use this service, was the time you waited: *

If you asked for assistance, did you get it when you needed it?: *

Thinking about your understanding and involvement in care

Did you feel you understood what was happening in your care?: *

Were things explained to you in a way that you could understand?: *

Were you involved as much as you wanted to be in decisions about your care?: *

Overall Experience

Using a scale of 0 – 10 where 0 is very bad and 10 is excellent, how would you rate your overall experience: *

Thinking of your responses

Equality monitoring

We are committed to ensuring that everyone receives fair and equal respect.

Whatever your age, disability, ethnicity, faith, gender reassignment or sexual identity, you can expect to be treated with dignity. We can only achieve this with your help by providing the information below.

Data will be used for monitoring purposes only and held in strictest confidence. Your identity will not be disclosed to anyone.

What is your age?: *

What is your gender?: *

At birth, were you described as: *

Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?: *

Which of the following options best describes how you think of yourself?: *

What is your religion?: *

Please choose one option that best describes your religion

What is your ethnic group?: *

Please choose one option that best describes your ethnic group or background

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Your NHS Wales Experience Questionnaire

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