Emergency Clinical Assessment and Triage Patient Survey

We would like you to think about your recent contact with the East of England Ambulance Service NHS Trust.

Q1. Overall, how was your experience of our service? *

Thinking about the service we provide...

Please confirm whether you are happy for your comments to be made public: *
Q2. Whose views are being reported in this questionnaire? *
Q3. Was the ambulance service the first place you contacted for help with your condition? *
Q4. Before contacting the ambulance service, where did you go to or contact for help with your condition? (If more than one option applies, select the last one you went to or contacted, before the emergency services)
Q5. Why did you call the emergency service following your contact with the service above? (Tick all that apply)
Q6. Before your call to the ambulance service, had you previously received advice/ treatment about the same condition or something related to it?
Q7. What was the outcome of your call with the ambulance service *
Q8. If you were treated over the phone, was it possible to follow the advice given?
Q9. Which service did the ambulance service advise seeing arranging an appointmen with?
Q10. Did the ambulance service explain why an ambulance would not be sent on this occasion?
Q11. Did you agree with the decision not to send an ambulance?
Q12. Was another health professional contacted within 48 hours about the same condition?
Q13. If yes, which health professional was contacted?

Equality and Diversity

The following questions are used to obtain demographic information about the patients we serve.

This information can help us plan to meet the needs of the community, to ensure that everyone has equal access to the health care we provide, and that we deliver our service to the same high standard for all our patients.

Completion of this page is entirely voluntary.

What age are you?
What best describes your gender?
What is your ethnic group?
Religious beliefs of the patient:
Sexual orientation of the patient:
Do you (the patient) have any of the following disabilities?
Are you married or in a civil partnership?
Are you currently pregnant or have had a child within the last 12 months?
Do you now, or have you ever, considered yourself to be transgender?
Did you require any of the following information in a different format to assist you with access to the service?
Do you feel any of the above strands of diversity may have affected the service you received from the East of England Ambulance Service NHS Trust?
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Thank you for taking the time to complete this questionnaire.
The information collated will be used to assist us in improving the services we provide.