Reading Well Books on Prescription for Dementia Confidential Feedback Form
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.