Cared-For ePROM Survey

	None of the time	A little of the time	Some of the time	Most of the time	All of the time
Someone you can count on to listen to you when you need to talk	Someone you can count on to listen to you when you need to talk None of the time	Someone you can count on to listen to you when you need to talk A little of the time	Someone you can count on to listen to you when you need to talk Some of the time	Someone you can count on to listen to you when you need to talk Most of the time	Someone you can count on to listen to you when you need to talk All of the time
Someone to give you information to help you understand a situation	Someone to give you information to help you understand a situation None of the time	Someone to give you information to help you understand a situation A little of the time	Someone to give you information to help you understand a situation Some of the time	Someone to give you information to help you understand a situation Most of the time	Someone to give you information to help you understand a situation All of the time
Someone to give you good advice about a crisis	Someone to give you good advice about a crisis None of the time	Someone to give you good advice about a crisis A little of the time	Someone to give you good advice about a crisis Some of the time	Someone to give you good advice about a crisis Most of the time	Someone to give you good advice about a crisis All of the time
Someone to confide in or talk to about yourself or your problems	Someone to confide in or talk to about yourself or your problems None of the time	Someone to confide in or talk to about yourself or your problems A little of the time	Someone to confide in or talk to about yourself or your problems Some of the time	Someone to confide in or talk to about yourself or your problems Most of the time	Someone to confide in or talk to about yourself or your problems All of the time
Someone whose advice you really want	Someone whose advice you really want None of the time	Someone whose advice you really want A little of the time	Someone whose advice you really want Some of the time	Someone whose advice you really want Most of the time	Someone whose advice you really want All of the time
Someone to share your most private worries and fears with	Someone to share your most private worries and fears with None of the time	Someone to share your most private worries and fears with A little of the time	Someone to share your most private worries and fears with Some of the time	Someone to share your most private worries and fears with Most of the time	Someone to share your most private worries and fears with All of the time
Someone to turn to for suggestions about how to deal with a personal problem	Someone to turn to for suggestions about how to deal with a personal problem None of the time	Someone to turn to for suggestions about how to deal with a personal problem A little of the time	Someone to turn to for suggestions about how to deal with a personal problem Some of the time	Someone to turn to for suggestions about how to deal with a personal problem Most of the time	Someone to turn to for suggestions about how to deal with a personal problem All of the time
Someone who understands your problems	Someone who understands your problems None of the time	Someone who understands your problems A little of the time	Someone who understands your problems Some of the time	Someone who understands your problems Most of the time	Someone who understands your problems All of the time

None of the time

A little of the time

Some of the time

Most of the time

All of the time

Someone you can count on to listen to you when you need to talk

Someone you can count on to listen to you when you need to talk None of the time

Someone you can count on to listen to you when you need to talk A little of the time

Someone you can count on to listen to you when you need to talk Some of the time

Someone you can count on to listen to you when you need to talk Most of the time

Someone you can count on to listen to you when you need to talk All of the time

Someone to give you information to help you understand a situation

Someone to give you information to help you understand a situation None of the time

Someone to give you information to help you understand a situation A little of the time

Someone to give you information to help you understand a situation Some of the time

Someone to give you information to help you understand a situation Most of the time

Someone to give you information to help you understand a situation All of the time

Someone to give you good advice about a crisis

Someone to give you good advice about a crisis None of the time

Someone to give you good advice about a crisis A little of the time

Someone to give you good advice about a crisis Some of the time

Someone to give you good advice about a crisis Most of the time

Someone to give you good advice about a crisis All of the time

Someone to confide in or talk to about yourself or your problems

Someone to confide in or talk to about yourself or your problems None of the time

Someone to confide in or talk to about yourself or your problems A little of the time

Someone to confide in or talk to about yourself or your problems Some of the time

Someone to confide in or talk to about yourself or your problems Most of the time

Someone to confide in or talk to about yourself or your problems All of the time

Someone whose advice you really want

Someone whose advice you really want None of the time

Someone whose advice you really want A little of the time

Someone whose advice you really want Some of the time

Someone whose advice you really want Most of the time

Someone whose advice you really want All of the time

Someone to share your most private worries and fears with

Someone to share your most private worries and fears with None of the time

Someone to share your most private worries and fears with A little of the time

Someone to share your most private worries and fears with Some of the time

Someone to share your most private worries and fears with Most of the time

Someone to share your most private worries and fears with All of the time

Someone to turn to for suggestions about how to deal with a personal problem

Someone to turn to for suggestions about how to deal with a personal problem None of the time

Someone to turn to for suggestions about how to deal with a personal problem A little of the time

Someone to turn to for suggestions about how to deal with a personal problem Some of the time

Someone to turn to for suggestions about how to deal with a personal problem Most of the time

Someone to turn to for suggestions about how to deal with a personal problem All of the time

Someone who understands your problems

Someone who understands your problems None of the time

Someone who understands your problems A little of the time

Someone who understands your problems Some of the time

Someone who understands your problems Most of the time

Someone who understands your problems All of the time

	None of the time	A little of the time	Some of the time	Most of the time	All of the time
Someone to help you if you were confined to bed	Someone to help you if you were confined to bed None of the time	Someone to help you if you were confined to bed A little of the time	Someone to help you if you were confined to bed Some of the time	Someone to help you if you were confined to bed Most of the time	Someone to help you if you were confined to bed All of the time
Someone to take you to the doctor if you needed it	Someone to take you to the doctor if you needed it None of the time	Someone to take you to the doctor if you needed it A little of the time	Someone to take you to the doctor if you needed it Some of the time	Someone to take you to the doctor if you needed it Most of the time	Someone to take you to the doctor if you needed it All of the time
Someone to prepare your meals if you were unable to do it yourself	Someone to prepare your meals if you were unable to do it yourself None of the time	Someone to prepare your meals if you were unable to do it yourself A little of the time	Someone to prepare your meals if you were unable to do it yourself Some of the time	Someone to prepare your meals if you were unable to do it yourself Most of the time	Someone to prepare your meals if you were unable to do it yourself All of the time
Someone to help with daily chores if you were sick	Someone to help with daily chores if you were sick None of the time	Someone to help with daily chores if you were sick A little of the time	Someone to help with daily chores if you were sick Some of the time	Someone to help with daily chores if you were sick Most of the time	Someone to help with daily chores if you were sick All of the time

None of the time

A little of the time

Some of the time

Most of the time

All of the time

Someone to help you if you were confined to bed

Someone to help you if you were confined to bed None of the time

Someone to help you if you were confined to bed A little of the time

Someone to help you if you were confined to bed Some of the time

Someone to help you if you were confined to bed Most of the time

Someone to help you if you were confined to bed All of the time

Someone to take you to the doctor if you needed it

Someone to take you to the doctor if you needed it None of the time

Someone to take you to the doctor if you needed it A little of the time

Someone to take you to the doctor if you needed it Some of the time

Someone to take you to the doctor if you needed it Most of the time

Someone to take you to the doctor if you needed it All of the time

Someone to prepare your meals if you were unable to do it yourself

Someone to prepare your meals if you were unable to do it yourself None of the time

Someone to prepare your meals if you were unable to do it yourself A little of the time

Someone to prepare your meals if you were unable to do it yourself Some of the time

Someone to prepare your meals if you were unable to do it yourself Most of the time

Someone to prepare your meals if you were unable to do it yourself All of the time

Someone to help with daily chores if you were sick

Someone to help with daily chores if you were sick None of the time

Someone to help with daily chores if you were sick A little of the time

Someone to help with daily chores if you were sick Some of the time

Someone to help with daily chores if you were sick Most of the time

Someone to help with daily chores if you were sick All of the time

Question Title

* 3. How confident are you and how often do you feel the following kinds of support and health services and care will be available to you (Select all that apply)

Someone you can count on to listen to you, even when you need to confide your fears and whose advice you really want

Someone to help you if you were confined to bed and unable to do daily chores

Someone who show you love and affection and makes you feel wanted

Someone to do things with to help you get your mind off things

	Excellent	Good	Adequate	Poor	Terrible
Convenience of location	Convenience of location Excellent	Convenience of location Good	Convenience of location Adequate	Convenience of location Poor	Convenience of location Terrible
Booking availability	Booking availability Excellent	Booking availability Good	Booking availability Adequate	Booking availability Poor	Booking availability Terrible
Telephone/internet access	Telephone/internet access Excellent	Telephone/internet access Good	Telephone/internet access Adequate	Telephone/internet access Poor	Telephone/internet access Terrible
Clinic waiting time	Clinic waiting time Excellent	Clinic waiting time Good	Clinic waiting time Adequate	Clinic waiting time Poor	Clinic waiting time Terrible
Time spent	Time spent Excellent	Time spent Good	Time spent Adequate	Time spent Poor	Time spent Terrible
Explanations Given to you	Explanations Given to you Excellent	Explanations Given to you Good	Explanations Given to you Adequate	Explanations Given to you Poor	Explanations Given to you Terrible
Technical Skills	Technical Skills Excellent	Technical Skills Good	Technical Skills Adequate	Technical Skills Poor	Technical Skills Terrible
Personnel Manner	Personnel Manner Excellent	Personnel Manner Good	Personnel Manner Adequate	Personnel Manner Poor	Personnel Manner Terrible
Visit overall	Visit overall Excellent	Visit overall Good	Visit overall Adequate	Visit overall Poor	Visit overall Terrible
Balance between Continuity and choice of care	Balance between Continuity and choice of care Excellent	Balance between Continuity and choice of care Good	Balance between Continuity and choice of care Adequate	Balance between Continuity and choice of care Poor	Balance between Continuity and choice of care Terrible
Being asked specific questions that relate to your desired outcomes of the consultation	Being asked specific questions that relate to your desired outcomes of the consultation Excellent	Being asked specific questions that relate to your desired outcomes of the consultation Good	Being asked specific questions that relate to your desired outcomes of the consultation Adequate	Being asked specific questions that relate to your desired outcomes of the consultation Poor	Being asked specific questions that relate to your desired outcomes of the consultation Terrible
Receiving advice on how you might minimise future illness episodes	Receiving advice on how you might minimise future illness episodes Excellent	Receiving advice on how you might minimise future illness episodes Good	Receiving advice on how you might minimise future illness episodes Adequate	Receiving advice on how you might minimise future illness episodes Poor	Receiving advice on how you might minimise future illness episodes Terrible
Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health	Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health Excellent	Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health Good	Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health Adequate	Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health Poor	Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health Terrible

Excellent

Good

Adequate

Poor

Terrible

Convenience of location

Convenience of location Excellent

Convenience of location Good

Convenience of location Adequate

Convenience of location Poor

Convenience of location Terrible

Booking availability

Booking availability Excellent

Booking availability Good

Booking availability Adequate

Booking availability Poor

Booking availability Terrible

Telephone/internet access

Telephone/internet access Excellent

Telephone/internet access Good

Telephone/internet access Adequate

Telephone/internet access Poor

Telephone/internet access Terrible

Clinic waiting time

Clinic waiting time Excellent

Clinic waiting time Good

Clinic waiting time Adequate

Clinic waiting time Poor

Clinic waiting time Terrible

Time spent

Time spent Excellent

Time spent Good

Time spent Adequate

Time spent Poor

Time spent Terrible

Explanations Given to you

Explanations Given to you Excellent

Explanations Given to you Good

Explanations Given to you Adequate

Explanations Given to you Poor

Explanations Given to you Terrible

Technical Skills

Technical Skills Excellent

Technical Skills Good

Technical Skills Adequate

Technical Skills Poor

Technical Skills Terrible

Personnel Manner

Personnel Manner Excellent

Personnel Manner Good

Personnel Manner Adequate

Personnel Manner Poor

Personnel Manner Terrible

Visit overall

Visit overall Excellent

Visit overall Good

Visit overall Adequate

Visit overall Poor

Visit overall Terrible

Balance between Continuity and choice of care

Balance between Continuity and choice of care Excellent

Balance between Continuity and choice of care Good

Balance between Continuity and choice of care Adequate

Balance between Continuity and choice of care Poor

Balance between Continuity and choice of care Terrible

Being asked specific questions that relate to your desired outcomes of the consultation

Being asked specific questions that relate to your desired outcomes of the consultation Excellent

Being asked specific questions that relate to your desired outcomes of the consultation Good

Being asked specific questions that relate to your desired outcomes of the consultation Adequate

Being asked specific questions that relate to your desired outcomes of the consultation Poor

Being asked specific questions that relate to your desired outcomes of the consultation Terrible

Receiving advice on how you might minimise future illness episodes

Receiving advice on how you might minimise future illness episodes Excellent

Receiving advice on how you might minimise future illness episodes Good

Receiving advice on how you might minimise future illness episodes Adequate

Receiving advice on how you might minimise future illness episodes Poor

Receiving advice on how you might minimise future illness episodes Terrible

Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health

Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health Excellent

Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health Good

Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health Adequate

Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health Poor

Your level of confidence that your consultation with your medical practitioner will lead to a treatment that will succeed in improving your health Terrible

Cared-For ePROM

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* 1. Emotional/informational support

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* 2. Tangible support

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* 3. How confident are you and how often do you feel the following kinds of support and health services and care will be available to you (Select all that apply)

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* 4. Thinking about times when you might require Hospital/Medical care how would you rate the following