CCS Evaluation form | Camden and Islington NHS Foundation Trust

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Cultural Consultation Service evaluation form

We value your feedback please take a moment to complete the valuation form.

Name

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Date *

How easy was it to:

Contact the service ?

Easy

Difficult

Arrange an appointment?

Easy

Difficult

Obtain a report of the consultation?

Easy

Difficult

Did you find the consultation helpful or unhelpful? Please state why. *

Was sufficient time allocated?

Yes

Did you learn anything from the consultation?

Do you think you could apply learnings from the consultation in your routine clinical work?

Were there any changes to the patients’ treatment, care plan, and.or diagnosis as a result of the consultation? For example: better engagement, early discharge, change of diagnosis, medications, carer involvement, etc. Please note this is not an exhaustive list.

Would you consider approaching the service in the future?

Please explain why

Do you have any suggestions for improving the service in any way?

Your profession:

Your team/service:

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In an emergency: Dial 999 or visit A&E

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Camden and Islington NHS Foundation Trust: St Pancras Hospital; 4 St Pancras Way; London NW1 0PE

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Cultural Consultation Service evaluation form

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