Agree Disagree To Say Prior to my appointment, my appearance has affected my involvement in social or leisure activities: Strongly Agree Neutral Disagree Strongly Prefer Not Agree Disagree To Say Prior to my appointment, my appearance has created problems within my relationships: Strongly Agree Neutral Disagree Strongly Prefer Not Agree Disagree To Say Prior to my appointment, I feel I have been stared at or asked questions, bullied or teased, or ignored because of my appearance: Strongly Agree Neutral Disagree Strongly Prefer Not Disagree To Say Agree Prior to my appointment, my appearance bothered me when I was with other people: Strongly Agree Neutral Disagree Strongly Prefer Not Disagree To Say Agree How often do you feel good about yourself at the moment? Hardly Not very Sometimes Fairly often Most of Prefer not the time to say ever often Thank you for completing the first part of our survey! You will receive the other parts after your appointment. Your feedback will help us to monitor, improve and develop our services and ensure we are meeting people’s needs.
Agree Disagree To Say Prior to my appointment, my appearance has affected my involvement in social or leisure activities: Strongly Agree Agree Neutral Disagree Strongly Disagree Prefer Not To Say Prior to my appointment, my appearance has created problems within my relationships: Strongly Agree Agree Neutral Disagree Strongly Disagree Prefer Not To Say Prior to my appointment, I feel I have been stared at or asked questions, bullied or teased, or ignored because of my appearance: Strongly Agree Agree Neutral Disagree Strongly Disagree Prefer Not To Say Prior to my appointment, my appearance bothered me when I was with other people: Strongly Agree Agree Neutral Disagree Strongly Disagree Prefer Not To Say How often do you feel good about yourself at the moment? Hardly ever Not very often Sometimes Fairly often Most of the time Prefer not to say Thank you for completing the first part of our survey! You will receive the other parts after your appointment. Your feedback will help us to monitor, improve and develop our services and ensure we are meeting people’s needs.
Feedback-1-pre-appointment.docx