Talk Liverpool - Friends And Family Form

Overall, how was your experience of our service? *

Very good

Good

Neither good nor poor

Poor

Very poor

Don't know

Please can you tell us why you gave your answer?

Are you?

Male

Female

Prefer not to say

Prefer to self describe

Gender Self Description

What age are you?

0-15

16-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

Do you consider yourself to have a physical or mental health condition or disability?

Yes

No

Details

Which of the following best describes your ethnic background?

Are you?

The patient

The parent or carer

The patient and parent/carer

If you DO NOT wish your anonymous comments to be shared then please tick here:

Consent for storing submitted data *

Yes, I give permission to store and process my data
No, I don't consent to storing and processing my data

The NHS Friends and Family Test