Clinic Evaluation Form

Please select which of the following applies to you

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

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?

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

Clinic Evaluation Form

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