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Q1. Do you have any long-standing health problems, disability or infirmity? Please include anything that has troubled you over a period of time or that is likely to affect you over a period of time.
Q2. Have you had discussions in the past 12 months with a Doctor or Nurse about how best to deal with your health problems?
Q3. In these discussions........(please tick ONE box in each of the following)
Did the doctor or nurse take notice of your views about how to deal with your health problem?
Did the doctor or nurse give you information about the things you might do to deal with your health problem?
Did you and the doctor or nurse agree how best to manage your health problem?
Did the doctor or nurse give you a written document about the discussions you had about managing your health problem?
Would you have liked a written plan summarising your discussion with the doctor or nurse?
Did the doctor or nurse ever mention that you had something called a care plan?
Q4. Do you think that having these discusions with your doctor or nurse has helped improve how you manage your health problems?
Q5. In the past 6 months have you had enough support from local services or organisations to help you manage your long-term health condition(s). Please think about all services and organisations, not just health services.
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To help us analyse your answers please tell us a few things about yourself:
Are you male of female?
What age are you?
What is the ethnic background with which you most identify?
How would you describe how often you come to the Health Centre?
Many thanks for your time in answering the questions on this survey