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Questionnaire

Manor House - New acute inpatient unit

Service user consultation

Welcome to the Manor House service user consultation questionnaire. Please take a few minutes to fill in this questionnaire and have your say on what should be available at the new site. Thank you for your time and patience.

Please click here if you would prefer the printable version.

Please rate the following on a scale of 1-4, where -
1 = Very important
2 = Important
3 = Not important
4 = Dont know

Bedrooms:

1 = Very important
2 = Important
3 = Not important
4 = Don't know
Individual rooms: 1 2 3 4
En-suite baths or showers: 1 2 3 4
Dormitories: 1 2 3 4
Air conditioning: 1 2 3 4
S.A.D. Lamps: 1 2 3 4
Agreed decor/colour scheme : 1 2 3 4
Day rooms:

1 = Very important
2 = Important
3 = Not important
4 = Don't know
Men only room: 1 2 3 4
Women only room: 1 2 3 4
Mixed room: 1 2 3 4
Games room: 1 2 3 4
Music / sensory room: 1 2 3 4
Chill-out room: 1 2 3 4
Crisis suite (Intensive Observation Unit): 1 2 3 4
Gym / sports hall: 1 2 3 4
Other facilities:

1 = Very important
2 = Important
3 = Not important
4 = Don't know
Cold water machine (accessible 24 hours): 1 2 3 4
Phones: 1 2 3 4
TV / CD / DVD: 1 2 3 4
Shop: 1 2 3 4
Laundry: 1 2 3 4
Visitor facilities:

1 = Very important
2 = Important
3 = Not important
4 = Don't know
Visitors suite / lounge: 1 2 3 4
Visitors phones: 1 2 3 4
Visitors TV / CD / DVD: 1 2 3 4
Visitors shop: 1 2 3 4
Visitors creche: 1 2 3 4
External areas :

1 = Very important
2 = Important
3 = Not important
4 = Don't know
Parking facilities: 1 2 3 4
Disabled access: 1 2 3 4
Garden / open space: 1 2 3 4
Sports area: 1 2 3 4
Please give your views on the following:
What therapies and treatments should be available on site?
What activities and groups would you like to see?
What are your views on having advocacy services on site?
What are your views on having an inpatients council?
What are your views on facilities for older adults?
In your experience of inpatient units, what worked best?
...and what didn’t work?
Any other comments?
About you
All the information below will be treated in the strictest confidence. We need to collect a few background details on everyone completing the questionnaire, so we can see how the responses vary depending on people’s age, gender, location, or ethnic origin.
Your age:
Under 18 18-25 26-35 36-45 46-55 56-65 65+
Your gender:
Male      Female
Your nearest town:
North Bucks:
Aylesbury:
Wycombe:
Amersham:
Chesham:
The Chalfonts:
South Bucks:
What is your ethnic origin?
White British
White Irish
White, other. Please specify
Pakistani
Indian
Bangladeshi
Asian, other. Please specify
Black African
Black Caribbean
Black, other. Please specify
Chinese
Other. Please specify
Please validate your questionnaire by typing the letters you see in the box. CAPTCHA Image

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Please check your answers, then click submit:
 

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Buckinghamshire Mind is a registered charity (1103063), a company limited by guarantee (5000185), and is affiliated to Mind. As a member of BACP we are bound by its ethical framework for good practice in counselling and psychotherapy, and subject to the professional conduct procedure therein.