Reading Well Books on Prescription for dementia Confidential feedback form

We would be grateful if you could answer the following questions. Your feedback is really useful in helping us to make sure that Reading Well Books on Prescription for dementia works well.

You can post this form to us at Reading Well Books on Prescription, The Reading Agency, Free Word Centre, 60 Farringdon Road, London, EC1R 3GA. Or, if you prefer, fill in the online form at: www.surveymonkey.com/s/RWBOPDementiaConfidentialFeedbackForm

1.  What was the title of the Reading Well Books on Prescription for dementia book that you borrowed?

______

2.  Was this book recommended to you by a health professional, e.g. GP or memory service provider?

Yes

No

3.  How much of the book did you read?

All of it

Relevant sections

None of it

4.  How helpful did you find it?

Not helpful Quite helpful Helpful Very helpful

5.  Did the book:

Yes No Don’t know

Improve your knowledge and understanding of dementia

Support you in living well/coping better with dementia

Give you support to care for someone with dementia

Increase your understanding of relevant services and sources of help

6.  Were you already a member of the library?

Please tick Yes No

7.  If you were not a member of the library, have you joined to borrow this book?

Please tick Yes No

About you

Which of the following best describes you (please tick one only):

Someone who has dementia

A relative or carer of someone who has dementia

Other (please specify below)

______


Age Under 19

19-24

25-44

45-64

65-74

74+

Sex

Male

Female

Ethnicity

White

Asian or British Asian

Black or British Black

Chinese

Mixed or dual heritage

Any other ethnic group

If you can, tell us the name of library authority where you borrowed the book

______

Many thanks for taking the time to complete this feedback form.

If you are happy to talk to us about your experiences of using the Reading Well Books on Prescription scheme, or have any other comments contact us at .

We will not use your contact details for any other purpose than to talk to you about the scheme.