NHSGGC Online Feedback Form

About your feedback

Who are you giving feedback as? *

Patient
Parent or Guardian
Relative
Carer

What kind of feedback are you leaving? *

Praise
Comments and Concerns

Share where your feedback is about

Please leave this question blank if you are unsure or would prefer not to specify a location.

Where are you giving feedback about?

Main Hospital
Child Development Centre
Day Hospital (Mental Health)
Health Centre or Clinic
Learning Disability Services
Maternity Hospital or Unit
Mental Health Hospital
Mental Health Resource Centre
Primary Care Mental Health Team

What Main Hospital(s) are you commenting on?

What Child Development Clinic(s) are you commenting on?

What Day Hospital(s) are you commenting on?

What Health Centre(s) or Clinic(s) are you commenting on?

What Learning Disability Service(s) are you commenting on?

What Maternity Hospital(s) or Unit(s) are you commenting on?

What Mental Health Hospital(s) are you commenting on?

What Mental Health Resource Centre(s) are you commenting on?

What Primary Care Mental Health Team(s) are you commenting on?

What does your feedback relate to?

Please leave these questions blank if you are unsure or would prefer not to specify which service, department or Ward.

What service(s) or department(s) is your feedback about?

If your service or department is not listed in the question above, please share:

What Ward or Clinic is your feedback about?

What is your feedback about?

What aspect are you commenting on? *

Accessing the building
Appointment
Catering
Hospital admission
Hospital discharge
Parking
Staff
Treatment
Transport
Waiting Times

Please share your feedback and comments. *

Stay in touch with NHSGGC

Would you like to be contacted about your feedback?

Yes, I'm happy to be contacted about my feedback

Email *

Our equalities monitoring questions help us to ensure we're actively engaging with all our communities. Do you have time to answer these questions?

Equality Monitoring Form

Why do we want information about you? The NHS is your health service and it should give you the care you need without treating you less favourably because of disability, age, religion and belief, sex, sexual orientation, gender reassignment, race, or how much money you have. Filling out this form helps us show we are involving people in a way that is fair for everyone. For example, if no disabled people have filled out the form, we’ll do more to find out why and make sure disabled people are given a fair opportunity to get involved. We will only use the information you give to look at the types of people we have included. We don’t want to know who you are so don’t write your name anywhere on this form.

What is your sex?

Male
Female
Other
Prefer not to say

Is current gender different to your gender at birth?

Yes
No
Prefer not to say

Please select your age group:

Under 16
16-24 Years
25-34 Years
35-44 Years
45-54 Years
55-64 Years
65-74 Years
75+ Years
Prefer not to say

What religion, religious denomination or belief do you identify yourself as?

None
Jewish
Atheist
Muslim
Buddhist
Church of Scotland
Roman Catholic
Other Christian
Hindu
Sikh
Another religion or belief

Please state your religion or belief:

Equality Monitoring Form

What is your ethnic group?

Prefer not to answer
White
Mixed or multiple ethnic groups
Asian, Asian Scottish, or Asian British
African
Caribbean or Black
Other ethnic group

White ethnic group:

Gypsy/Traveller
Irish
Other British
Polish
Scottish
Other white ethnic group

Please state your other White ethnic group:

Please state your mixed or multiple ethnic groups:

Asian, Asian Scottish, or Asian British ethnic group:

Bangladeshi, Bangladeshi Scottish or Bangladeshi British
Chinese, Chinese Scottish or Chinese British
Indian, Indian Scottish or Indian British
Pakistani, Pakistani Scottish or Pakistani British
Other

Please state your other Asian, Asian Scottish, or Asian British ethnic group:

African ethnic group:

African, African Scottish or African British
Other

Please state your other African ethnic group:

Caribbean or Black ethnic group:

Caribbean, Caribbean Scottish or British
Black, Black Scottish or Black British
Other

Please state your other Caribbean or Black ethnic group:

Other ethnic group:

Arab, Arab Scottish or Arab British
Other

Please state your other ethnic group:

Do you need an interpreter or other communication support?

Yes
No
Prefer not to answer

Which of the following options best describes how you think of yourself?

Bisexual (attracted to same and opposite sex)
Heterosexual/Straight (attracted to opposite sex only)
Gay or Lesbian (attracted to same sex only)
Other
Prefer not to answer

Do you have a physical or mental health condition or illness lasting, or expected to last 12 months or more?

Yes
No
Don't know
Prefer not to answer

If yes, does your condition or illness reduce your ability to carry out day-to-day activities?

No, not at all
Yes, a little
Yes, a lot

Does this condition or illness affect you in any of the following areas?

A long term illness (such as diabetes, cancer, HIV, heart disease or epilepsy)
Dexterity (for example lifting or carrying objects, using a keyboard)
Hearing (for example deafness or partial hearing)
Learning, understanding or concentrating
Memory
Mental health
Mobility (for example walking short distances or climbing stairs)
Socially or behaviourally (for example associated with autism, attention deficit disorder or Asperger’s syndrome)
Stamina, breathing or fatigue
Vision (for example partial sight or blindness)
Other
None of the above
Prefer not to answer

Please state the other area(s) the condition or illness affects you:

Please share the Health and Social Partnership that covers where you live: