CCS Evaluation form | Camden and Islington NHS Foundation Trust

Cultural Consultation Service evaluation form

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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

No

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:

Contact details
Dr Sushrut Jadhav
Cultural Consultation Service
Greenland Road
London NW1 0AS

Tel: 020 3317 6590
Email: sushrut.jadhav@candi.nhs.uk s.jadhav@ucl.ac.uk

Cultural Consultation Service evaluation form

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