OT ARF clinic evaluation

1. Which option best describes the person completing this survey?

(Required) I am a patient who attended the clinic I am a carer, family member or support person for someone who attended the clinic

2. Which Occupational Therapy clinic did you attend?

(Required) Oedema Management Clinic Palliative Care Outpatient Clinic Cognitive Assessment Clinic Rapid Access Hand Therapy Service

3. Overall, how would you rate your experience with this service?

(Required) Very good Good Adequate Poor Very Poor

Why did you provide this rating? (Required)

4. Did the care and treatment you received help you?

(Required) Yes, definitely helped Yes, it helped to some extent No, did not help at all

5. If you didn't come to the clinic, where would you seek care?

(Required) GP ED Outpatient clinic Other

If other, please indicate where you would seek care

6. Was there anything really good about the care you received?

(Required) Yes No

If anything, please specify what was really good about the care you received

7. Was there anything about the care you received that could be improved?

Please specify what could be improved about the care received (Required)

8. Thinking about your experience of care, please tell us what the benefits were?

Free text (Required)

9. Thinking about your experiences of care, please tell us what the challenges were?

Free text (Required)

10. Would you recommend this service?

(Required) Yes No

11. Would you be happy to be contacted at a later date to discuss your experience with this service?

(Required) Yes No

If yes, please record URN or contact details

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