Incident

Please contact our media team for information relating to incidents

Maternity Services Survey

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

How did you hear about the online survey? *

If you selected the above option 'I received a letter though the post', please provide below the REF1 & REF2 which can be found on the top right hand side of letter.

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. Are you the patient? *
Q3. Who contacted the ambulance service for this incident? *
Q4. What was your reason for contacting the ambulance service? *
Q5. Please tell us if you had contact with any of the following health providers before contacting the ambulance service for this incident: *
Q6. How would you rate the handling of your emergency phone call to the ambulance service? *
Q7. How would you describe the length of time you waited for the ambulance service to arrive? *
Q8. Did you receive a single responder in a car or a crew with an ambulance? *
Q9. How would you describe the attitude of the ambulance service staff that you had contact with? *
Q10. Did the ambulance service staff treat you with dignity and respect? *
Q11. Did the ambulance service staff request to see your handheld maternity notes? *
Q12. Did the ambulance service staff examine you in any way or perform an assessment? *
Q13. Were you satisfied with the advise you received from the ambulance service? *
Q14. Did you feel the ambulance service staff managed your pain appropriately? *
Q15. How involved do you feel you were in the decisions made regarding your care? *
Q16. How satisfied were you with the care you received from the ambulance service staff? *
Q17. How would you describe the service you received in relation to your expectations? *

Would you like to compliment the service or staff?

If you wish to send a separate note of thanks to the initial call handler or staff involved, you may add your comments to the below box, please also include your name and contact details to ensure such correspondence is passed on to the appropriate people.

Would you like to take part in a patient interview?

We are looking for patients who would be willing to discuss their experience with the East of England Ambulance Service NHS Trust in more depth. The information obtained from patient interviews will be used to assist us in improving the services provided by the Trust.

Would you like to inform us of a concern or complaint?

All comments received are used to monitor and improve the services provided by the Trust. If you have a concern or complaint about the service you have received and would like us to contact you, please complete the below box and provide your name and telephone number.

Please be aware that you can withdraw your consent for the East of England Ambulance Service NHS Trust to use and store the information you have provided at any time. If you wish to withdraw your consent to your details being held, please contact the Patient Survey Team either via email: surveys@eastamb.nhs.uk or by telephone 01603 422757.

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 heath care provided and for the service to be delivered to a high standard for all of our patients.

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 that 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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If you would like to become involved, represent your community and feel you can be an ambassador for EEAST research, then we would love to hear from you, please register your interest

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.