LAC 10 -18yrs feedback form

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10 -18yrs feedback form

Please select if this is your initial health assessment or a review of your health assessment

Initial health assessment Health assessment review

Question 1

The health professional explained what would happen during the health assessment.

Yes No

Comment

Question 2

The health professional listened to what I had to say.

Yes No

Comments

Question 3

I was given opportunity to talk to the health professional on my own.

Yes No

Comments

Question 4

I was told that part of the completed Health Assessment would be shared with others that support me, i.e Social Worker/GP/ Foster carer.

Yes No

Comments

Question 5

I felt ‘comfortable’ talking with the health professional about various topics.

Yes No

Comments

Would you prefer your health assessment with the Nurse or Doctor to be (please tick your preferred choice)

Face to face via Telephone via Video

If Face to face is your preferred option, where would you like to have your health assessment? (please tick your preferred choice)

Home Clinic School Other

Managing local authority

Who is your local authority?

East Coast Community Healthcare CIC

Hamilton House
Battery Green Road
Lowestoft
Suffolk
NR32 1DE

Tel. 01502 445445

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