Diabetes Services in Croydon - Survey 2007

In partnership with Diabetes UK and other local organisations, Croydon Primary Care Trust is carrying out a review of Diabetes Services.  We would like to get the views of as many people living with diabetes as possible, to enable us to plan future service developments around the needs that you identify as important to you.

Please complete the form below and

either send to: Kendel Fairley, Project Manager - Primary Care Services, Croydon PCT, Leon House, 233 High Street, Croydon CR0 9XT

or save the form as a Word document and email it as an attachment to:kendel.fairley@croydonpct.nhs.uk

Forms should be returned by Monday 1 October 2007.  All information received is anonymous and confidential: no one will be able to identify you from your responses.

If you have difficulty completing the form, please feel free to ask a friend, relative or carer to help you, or phone Kendel Fairley at Croydon PCT on 020 8274 6105 or email: kendel.fairley@croydonpct.nhs.uk

SURVEY FORM

Q2.  How old were you when you were first diagnosed with diabetes?  (please tick)

Q3.  Who do you go to see for your regular diabetes check-ups, where your test results and treatment are reviewed?  (please tick)

Q4.  Which of the following services have you used in the last year?  (please tick as many that apply)

Q5.  What three things do you like about the services you currently receive in relation to your diabetes?  (please add more points if you would like to)

1.

2.

3.

Q6.  In the list below please tick any that would help you to look after your diabetes better:

1. A personal record of your treatment and test results

2. Information leaflets or treatment information in your own language - if yes, which language?

3. Regular update sessions with diabetes professionals

4. Support from other people with diabetes

5. Other (please state)

Q7.  Please add any further suggestions in the space below that would improve your experience of living with diabetes.

Finally, it would help us to ensure that our services are fair and can meet everyone’s needs if you could tell us a little bit about yourself:

Q8.  Are you      Male      Female      (please tick)

Q9.  What is your age? …………

Q10.  Which ethnic group do you belong to?  (please tick)

Thank you for taking the time to complete the survey.