Lay Carer -administered subcutaneous injections: your feedback

This is for completion by family and informal carers

(Alternative feedback forms are available for healthcare professionals)

You can give anonymous feedback, or if you are happy for us to get in touch you can provide your name and contact details:

1. Please give the name of the patient’s GP surgery:

2. What is your relationship to the patient?

3. Did you feel under pressure to undertake this training, at any point? Please give details

4. The training process was: (please select, and add any additional comments)

Too hard to understand A bit hard, but okay Clear

Additional Comments

5. The wording throughout the booklet was: (please select, and add any additional comments)

Too hard to understand A bit hard, but okay Clear

Additional Comments

6. Did you feel well prepared after completing the training?

7. Did you administer any injections to the patient? If yes, please estimate how many times

8. If you did not give any injections, why was that? Please tick, and add any additional comments

Other reason:

9. Did you come across any problems when giving an injection? If yes, please give details

10. If you gave any injections, did you feel this helped the patient’s level of comfort?

11. How do you feel overall about this process? Please give details

12. Would you recommend this training to those in a similar situation to yourself? Please give details

13. Suggestions for improvements or other comments: