Patient Questionnaire for Paramedic Visiting Service

Are you filling this questionnaire in for

 
 
 
 

On a scale from 1 to 5, how important to your health and wellbeing was your reason for a home visit today?

 
 
 
 
 

How good was Claire at being polite?

 
 
 
 
 
 

How good was Claire at making you feel at ease?

 
 
 
 
 
 

How good was Claire at listening to you?

 
 
 
 
 
 

How good was Claire at assessing your medical conditions?

 
 
 
 
 
 

How good was Claire at explaining your condition and treatment?

 
 
 
 
 
 

How good was Claire at involving you in decisions about your treatment?

 
 
 
 
 
 

How good was Claire at providing or arranging treatment for you?

 
 
 
 
 
 

I am confident in this paramedics ability to provide care

 
 

How strongly do you agree or disagree with the following statement - ability to keep information confidential

 
 
 
 
 
 

How strongly do you agree or disagree with the following statement - honest and trustworthy

 
 
 
 
 
 

How satisfied are you with the paramedic visiting service?

 
 
 
 

Would you be happy to see a paramedic from the GP surgery again?

 
 

What would you have done should a home visit have not been done today?

 
 
 
 
 

Please provide any further feedback about the paramedic visiting service

Are you

 
 

Age

 
 
 
 
 

What is your ethnic group