Sussex Experience Form (Easy Read version)

	Which Team does this relate to? (* Required)
	We want to know what it was like for you.
	Who are you?
	Service User?
	Carer?
	Both?
	Who did you see?
	Speech and Language Therapist
	Physiotherapist
	Occupational Therapist
	Psychiatrist
	Learning Disability Nurse
	Behaviour Therapist
	Psychologist
Question 1
	How was the help?
	Good
	Okay
	Bad
	Don't know
	You can tell us about your experience here What did you find helpful / unhelpful
Question 2
	Did the service listen to what you think about your care? Did the service do something about what you said?
	Yes
	No
	Some of the things
	Don’t know
	You can tell us about this here What did you find helpful / unhelpful
Question 3
	Do you have a care plan?
	Yes
	No
	Don’t know
	You can tell us about this here What did you find helpful / unhelpful
Question 4
	Have you had a care review meeting in the last 12 months?
	Yes
	No
	Don’t know
	You can tell us about this here What did you find helpful / unhelpful
Question 5
	Do you know what will happen next with your care and treatment?
	Yes
	No
	Don’t know
	You can tell us about this here What did you find helpful / unhelpful
Question 6
	If you had a crisis out of office hours, for example at the weekend or at night, do you know who to contact in the NHS?
	Yes
	No
	Don’t know
	You can tell us about this here What did you find helpful / unhelpful
Question 7
	Please tell us what we can do better?

	If you need help to fill in this form ask someone you trust

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