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Clinic Evaluation Form
Clinic Evaluation Form
Please select which of the following applies to you
aged 10 or under
aged 11 to 13
aged 14 or over
parent/carer/guardian
Please rate the following on a scale of 1 to 5; with any comments. 1: Very poor / 2: poor / 3: Neutral / 4: Good / 5: Very good/excellent
Information/assistance received before appointment
1
2
3
4
5
N/A
What would have made you score us higher?
General support and care during clinic
1
2
3
4
5
What would have made you score us higher?
Appointment with Psychologist
1
2
3
4
5
N/A
What would have made you score us higher?
Appointment with Neurology
1
2
3
4
5
N/A
What would have made you score us higher?
Appointment with Endocrinologist
1
2
3
4
5
N/A
What would have made you score us higher?
Appointment with Generic Doctor
1
2
3
4
5
N/A
What would have made you score us higher?
Appointment in Eye Department (tests)
1
2
3
4
5
N/A
What would have made you score us higher?
Appointment with Eye Doctor
1
2
3
4
5
N/A
What would have made you score us higher?
Appointment in Urology Department
1
2
3
4
5
N/A
What would have made you score us higher?
Appointment with Marie (Transitions Coordinator)
1
2
3
4
5
N/A
What would have made you score us higher?
Appointment with Research (Eurowabb) Department
1
2
3
4
5
N/A
What would have made you score us higher?
Appointment with Audiology (hearing) department
1
2
3
4
5
N/A
What would have made you score us higher?
Input from Becca, the Play Specialist
1
2
3
4
5
N/A
What would have made you score us higher?
Overall organisation
1
2
3
4
5
What would have made you score us higher?
The quality of food at hospital
1
2
3
4
5
What would have made you score us higher?
Do you feel you know more about Wolfram Syndrome after attending the clinic?
Yes, definitely
Yes, to some extent
No
Did the clinic visit help you feel supported in managing your child’s condition?
Yes
No
Did the doctors listen to what you had to say?
Yes, always
Yes, sometimes
No
Do you feel more confident about managing your child’s condition after attending clinic?
Yes, definitely
Yes, to some extent
No
When you had important questions to ask a doctor, did you get answers that you could understand?
Yes, always
Yes, sometimes
No
Did a member of staff explain the results of your child’s tests in a way you could understand?
Yes, definitely
Yes, to some extent
No
I was never told the results of the tests
Did the doctors or staff ask you what was important to you in managing your child’s condition?
Yes, definitely
Yes, to some extent
No
Don't know/can't say
How would you rate your overall experience of the clinic?
1 (a poor experience)
2
3
4
5 (a very good experience)
What was the best part of the clinic?
What was the worst part of the clinic?
How can we make the clinic better next time?
Please say which of your appointments went well and which ones went less well, and why:
Psychologist
Neurologist (Raj)
Endocrinologists (Prof Barrett/Dr Dias)
Genetics (Denise)
Eye Doctor (Archana/John)
Bladder Doctor (Liam)
Transitions (Marie)
Did Becca the Play Specialist help you feel better about having your blood test and scan?
Yes
A bit better
Not really
No
Do you feel you know more about Wolfram Syndrome after attending this clinic?
Yes
A bit more
Not really
No
Did you understand what each of the doctors do?
Yes
A bit
Not really
No
Did the clinic visit help you feel you could manage your condition better?
Yes definitely
Yes a bit
No
Did you understand what the doctors talked about?
Yes
A bit
Not really
No
Did the doctors listen to what you had to say?
Yes always
Yes sometimes
No
When you had important questions to ask the doctors, did you get answers you could understand?
Yes always
Yes sometimes
No
Did the doctors ask your parents questions that they should have asked you?
Yes
Yes sometimes
No
Did the doctors or other staff ask your parents questions they should have asked you?
Yes often
Yes sometimes
No
What was the best part of the clinic?
What was the worst part of the clinic?
How can we make the clinic better next time?
Thank you for taking time to complete this clinic feedback form. Please click on the below 'submit' button
Which of your appointments were good and which were not so good?
Psychologist
Good
Not good
Neurologist (Raj)
Good
Not good
Endocrine (Tim/Renuka)
Good
Not good
Genetics (Denise)
Good
Not good
Eye doctor (Archana/John)
Good
Not good
Bladder doctor (Liam)
Good
Not good
Did you understand what the doctors talked about?
Yes
No
Did you understand what each of the doctors do?
Yes
No
Did the doctors ask your Mum or Dad questions they should have asked you?
No
Yes
Sometimes
Did the doctor’s listen to what you had to say?
Yes
No
Do you know more about Wolfram Syndrome now?
Yes
No
Did Becca the Play Specialist help you feel better about your blood test and scan (MRI)?
Yes
No
What was the best part of the clinic?
What was the worst part of the clinic?
How can we make the clinic better next time?
Thank you for your help
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