1. Patient Experience, Annual Questionnaire
February 2016
What is this survey about?
This survey is about the care you have received at the Sexual Health Sheffield Service. We want to gain information on your experience of your visit here today and on your overall experiences of the service. It should take no longer than 10 minutes to complete. Your feedback is important to us to help improve services.
Completion of this questionnaire is voluntary
If you choose not to take part in this survey it will not affect the care you receive from the NHS in any way. If you do not wish to take part or you do not want to answer some of the questions, you do not have to give us a reason.
Your answers will be treated in complete confidence and all responses will be completely anonymous.
Completing the questionnaire:
Please answer these questions about your overall experiences of the service, including your most recent visit.
For each of the multiple choice questions please mark your answer with an X .
Once completed please save the version with your answers and it to Your answers will be treated in complete confidence.
If you have any questions about filling in the survey or if you raised anything you would like specific feedback on please contact us on or via on

2. About you: Are you? 6. To which of these ethnic groups do you belong?
o Female
o Male
o Prefer not to say
2. Was this the sex you were assigned
at birth?
o Yes
o No
6. To which of these ethnic groups do you belong?
a. WHITE
o British
o Irish
o Any other white background
b. MIXED
o White and Black Caribbean
o White and Black African
o White and Asian
o Any other mixed background
c. ASIAN OR ASIAN BRITISH
o Indian
o Pakistani
o Bangladeshi
o Any other Asian background
d. BLACK OR BLACK BRITISH
o Caribbean
o African
o Any other black background
e. CHINESE OR OTHER ETHNIC GROUP
o Chinese
o Any other ethnic group
  3. How old are you?
o 13-15
o 16-19
o 20-24
o 25-34
o 35-44
o 45-54
o 55-64
o 65+
4. What language do you speak most often at home? Please tick one box only
 English
 Other European language
 Asian language (such as Hindi, Gujarati, Punjabi, Urdu, Sylheti, Bengali, Chinese, Thai)
 African language (such as Swahili, Hausa, Yoruba)
 Other, including British Sign Language (please specify)
7. Do you have a physical or mental impairment which has an effect on your ability to carry out day to day activities?
o Yes
o No
If yes, please specify
5. Are your sexual partners?
o Men
o Women
o Both men and women
o Prefer not to say

3. About us: Access to service:
8. Over the last year (January ) how many times have you visited us?
o 1- 2
o 3 - 4 o
o 10+
13. Was the reception area welcoming when you arrived at the clinic?
o Yes, definitely
o Yes, to some extent
o No
14. What was the manner in which you were treated by the reception staff?
o Poor
o Fair
o Good
o Very good
o Excellent
9. Which site have you attended?
(mark all that apply)
o Hallamshire (GU Medicine)
o Central (Central Health Clinic)
o Firth Park
10. What was the main reason for
attending your most recent visit at clinic?
 Concern about symptoms
 Check-up
 Follow-up appointment
 To get test results
 Contraception
 Other (please specify)
15. Was the booking-in process at reception organised and easy to follow?
o Yes, definitely
o Yes, to some extent
o No
16. Before you attended the clinic today, did you know what would happen during the appointment?
o Yes, definitely
o Yes, to some extent
o No
11. How did you find out about our service?
o Already knew about service
o Internet
o Friend/Relative
o Other (please specify)
17. In relation to your appointment slot, were you…
o Seen on time, or early
o Waited up to 5 mins
o Waited mins
o Waited mins
o Waited more than 30 mins
o Don’t know/Can’t remember
o I arrived late for my appointment .
12. Was your appointment today:
o Pre-booked
o Walk in/ appt. allocated on arrival
o Youth clinic drop-in
o Other (please specify)

4. Experience of health care staff
18. If you attended a pre-booked appointment was the time and date convenient for you?
o Yes, definitely
o Yes, to some extent
o No
21. Who did you see at your most recent visit?
 Doctor
 Nurse
 Health Advisor
 Clinical Support Worker
 Sexual Health Promotion Practitioner
 Psychologist
 Don’t know
 Other (please specify)
19. In your opinion, how clean was the clinic?
o Very clean
o Fairly clean
o Not very clean
o Not at all clean
o Did not notice
20. In your opinion, how clean were the toilets at the clinic?
o I did not use a toilet
Please rate how much you agree with the
following statements in relation to the
clinician that you saw:
22. The warmth of the health care staff greeting me was…
 Excellent
 Very good
 Good
 Fair
 Poor
23. I would rate the ability of health care staff to listen to me as…
 Excellent
 Very good
 Good
 Fair
 Poor

5. Overall experience:
24. The information provided to me by the health care staff was…
 Excellent
 Very good
 Good
 Fair
 Poor
Please tick how much you agree with the
following statements :
28. ‘I felt the reason I attended my most recent clinic visit was addressed’
 Strongly agree
 Agree
 Unsure
 Disagree
 Strongly disagree
25. My confidence in the ability of health care staff is…
 Excellent
 Very good
 Good
 Fair
 Poor
29. ‘I felt that my care was confidential’
 Strongly agree
 Agree
 Unsure
 Disagree
 Strongly disagree
26. The respect shown to me by the member of health care staff was…
 Excellent
 Very good
 Good
 Fair
 Poor
30. ‘I did not feel judged by the staff’
 Strongly agree
 Agree
 Unsure
 Disagree
 Strongly disagree
27. The amount of time given to me by the member of health care staff was…
 Excellent
 Very good
 Good
 Fair
 Poor
31. How satisfied are you with the overall service you have received over the past year, including your most recent visit?
 Highly satisfied
 Satisfied
 Unsure
 Dissatisfied
 Very dissatisfied

6. Thank you for completing the survey
32. Please tell us what you felt was really good about the care you received from our service:
33. Was there anything you didn’t like or anything that you feel needs improving?
34. Have you got any other comments on your experiences of our service or filling out this
Questionnaire?
Do you want to get involved? You can become a Foundation member of Sheffield Teaching Hospitals NHS Foundation Trust . This will provide you with up to date information about this Trust and the opportunity to become involved in projects related to the ongoing  development sexual health services in the future.
If this is something you would like to do, you can complete a foundation Trust Member Questionnaire and give it back to us today or we can send you one in the post if you have provided your details on this form.
Thank you for completing the survey
Please check you have completed all the questions
Please place the questionnaire in the box provided in reception