11%
Questions marked with a * are required Exit Survey
 
 
The Forum's "Save our NHS" Group is working to gather data to inform the London Borough of Lewisham's Healthier Communities Select Committee of the actual state of Care in the Community.
If you have ever been a carer or received support or care in Lewisham, or if you live in Lewisham and have stayed in hospital for at least one night, please help us piece together a picture of care services and hospital discharge in Lewisham by answering the questions that follow.

This is not fully straightforward - so do take your time.

If you would like hard copies of the survey to share with friends or neighbours who come within these criteria but don't "do" on-line surveys please contact the Forum office on 020 8690 7869 or at the email address specified below.

Thank you very much for your time and support.  

Please start with the survey now with the questions below.  Do note that some answers will skip you forward to the next relevant qustion, and that in Section 3 you can complete the details of three hospital stays.  If you would like to give more comment, or comment on other services, e.g. occupational therapists, district nurses, etc., please e-mail on the address below.
 
 
 
Section 1  A picture of who you are
 
 
 
* Your age
   
 
 
 
Your gender
 
Male
 
Female
 
 
 
* Your postcode
   
 
 
 
* Relationship and support status (Question 1)  Are you....?
 
single
 
married or equivalent
 
separated
 
divorced
 
widowed
 
 
 
* Relationship and support status (Question 2) about family other than spouse or partner, i.e. in-laws, children, siblings, nephews, neices, etc.  Do you have....?
 
family (as well as spouse/partner) close by
 
no family (other than spouse/partner) near by
 
no family in the country
 
no family
 
 
 
Relationship and support status - fuller comment
   
 
 
 
* Mobility  Would you describe yourself as...?
 
housebound
 
able to get around with assistance (i.e. taxi-card or dial-a-ride)?
 
able to use most public transport
 
fully active
 
Other
 
 
 
 
* Work and life experience  What best describes you currently or before retirement.. ?
 
home-maker
 
caring vocation
 
clerical
 
manual
 
retail or service industry
 
professional
 
Other
 
 
[email protected]    020 8690 7869