Paediatric Respiratory Clinic

You were recently seen in the paediatric respiratory clinic with Advanced Nurse Practitioner James and Respiratory Specialist Nurse Deb. We would be most grateful if you would take the time to complete the below feedback questionnaire to help us improve our service.

Your Details

Name

Date of Birth
For example, 15 3 1984

Day

Month

Year

Phone Number (optional)

Email Address
FEEDBACK

What was the most valuable part of the appointment?

Length of appointment

Advice from specialist asthma nurse

Asthma action plan

Review of Medication

Referral to other services

Lung function testing

Other

Please enter details here

Can you think of ways we can improve the asthma clinic in the future, please write below any suggestions?

The specialist respiratory community care clinic was better than being seen at the at the hospital (considering parking and travel costs etc). With 1 being strongly agree and 5 being strongly disagree, to what extent do you agree or disagree. (optional)

1

2

3

4

5

How long did you wait to be seen from the moment you were referred for an appointment?

You saw the Respiratory Nurse Consultant Deb, do you have any specific feedback?

You were referred and seen by ANP James; do you have any specific feedback?

Do you feel that your child’s condition has improved as a result of being reviewed in the specialist clinic?

Was the communication following the appointment helpful including clinic summary letters, action plans for home and school?

Does your child have any specific feedback?

Do you have any other comments that may help us improve this service?

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Paediatric Respiratory Clinic

Paediatric Respiratory Clinic

Your Details

FEEDBACK