LINks Stockports community voice

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LINk Member/Community Feedback Form

This form is to help you feedback your health and social care experiences, views, ideas and suggestions to the LINk. These will be collected and used to identify trends and patterns. The LINk will use the feedback to prioritise which services require for further examination. Please remember we want to hear good practice accounts as well as not so good.

Contact Name:
Telephone:
Your Email Address :
Are you a LINk member?	Yes No
Group representing: If applicable

Todays date:
When did the incident/experience take place?
Where did the incident take place?	GP Practice Dentist Practice Own Home Optician Care home Pharmacy Day Centre Stepping Hill Hospital Ward or department: Other (please state below)
Who was involved?	Nurse Doctor Carer Social Care Staff Dentist Optician Pharmacist Reception/Clark Staff Other (please state below)
What happened?
Have or did you raise your concern with this service to an external body and if so please give details of who and if anything happened as result?
Suggestions for improvement:

Individual names of LINk members will not be shared with third parties and issues and general themes will be shared with statutory organisations.

Stockport LINk is supported through Pebble Enterprises
Co No 06506546, Charity No 1139131