Share your story | Healthwatch Central West London

Postcode or Borough*
When did you use this service
Have you (or a person you care for) seen a health or care professional in the last 12 months?*
- Yes
- No
- I wanted to, but couldn't get an appointment
If you couldn't get an appointment, please tell us more
Why did you see, or want to see, a health or social care professional?
Where did you see them?*
- GP Practice
- Dental Surgery
- Optician Surgery
- Pharmacy
- Hospital
- Home
- Care Home
- If other, please let us know below.
Name of service
If known, please name the service you used, for example the name of a hospital.
How was your experience?*
Say how satisfied you were with the service you visited
- Excellent
- Good
- Okay
- Poor
- Unacceptable
What was good or not good about your experience and what would make it better?
If you selected 'other' from the list of services above, please write it in this box as well as your experience of it.
Data storage*
Your experience of health and social care will be stored anonymously, and will be kept on our database for up to two years. If you chose to sign up to our mailing list, we will store your contact details separately. By signing up to our mailing list, you will receive email updates from us about our work, events we are holding, opportunities to be involved and other relevant information. You will also receive information on community, NHS, or local authority events, consultations, or news, and other information that is related to health and social care, both locally and nationally.
- In completing this form I consent to this form data being stored in the Healthwatch Central West London database
Mailing list
Would you like to find out more about our work and how you can get involved by joining our mailing list?
- Join mailing list
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Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
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Comments
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