North Middlesex University Hospital
Outpatient Services Survey - Sexual Health Clinic
Your views are very important to us. We want you to tell us how we are doing by answering this short survey.
We would like you to think about your recent experiences of our services.
1. How likely are you to recommend our clinic to friends and family if they needed similar care or treatment?

2. Please can you tell us the main reason for the score you have given?
Do you want your comments to be made public?
3. If we could change one thing about your care or treatment to improve your experience, what would it be?
4. If there is anything else you would like to tell us about any aspect of your care, please do so here. Please remember, any foul or abusive language will cause your feedback to be disregarded.
Please answer the following background questions about yourself. Please tick appropriate box.
5. Are you male or female?
6. What age band are you?

7. Do you have any of the following long standing conditions?

8. What is your ethnic group?

If other, tell us more
9. What is your religion?

10. Which of the following best describes how you think of yourself?

Thank you for taking the time to provide us with your feedback

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