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Pre Memory Assessment Survey
Thank you for agreeing to take part in our survey as part of the Memory Assessment Project.
We would like this survey to be completed by:
- people who have recently had an appointment at a memory service;
- people who have been referred for a memory service appointment;
- families, partners and friends of people above.
Your responses to the survey questions will give us a view of the challenges that need to be addressed during the period of time leading up to an appointment at a memory assessment service.
Survey responses will not be linked to any specific service or location.
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Have you already had an appointment at a memory assessment service?
Yes
No
Clear selection
When is your appointment due to take place, or if you have had your appointment how long did you wait from referral to appointment?
Within 2 weeks
2-4 weeks
More than 4 weeks
Not sure
Other:
Clear selection
After being referred to the memory assessment service by your GP, were you given any information or details of someone you could contact for further information or support?
Yes
No
Not sure
Clear selection
If you answered "yes" to the above please give details. If you answered no you can leave this question blank.
Your answer
Did you seek out further information or support during the time leading up to your appointment at the memory service?
Yes
No
Not sure
Clear selection
If you answered "yes" to the above please give details of what information you were looking for or who or who you contacted. If you answered no you can leave this question blank.
Your answer
In the time leading up to your appointment at the memory assessment service, do you or did you have concerns about any of the following:
Health needs
Health needs means anything relating to the delivery of health care for example treatment options, testing and diagnosis, support for other health considerations
Yes
No
Not sure
Clear selection
Practical needs
Practical needs include things like knowing your next steps and what other organisations you could contact for support, support getting to and from appointments if needed
Yes
No
Not sure
Clear selection
Emotional and wellbeing needs
Emotional needs consider your mental health, how you felt during your appointment and the emotional support which was available to you
Yes
No
Not sure
Clear selection
Social needs
Social needs consider maintaining connection to family/friends/community, and ensuring friends and family were able to be part of the appointment
Yes
No
Not sure
Clear selection
If you do or did have any concerns about the issues listed above or any other issues, did you receive any support in the time leading up to your appointment at the memory assessment service?
Yes
No
Not sure
Not applicable
Clear selection
If you did receive support in the time leading up to your appointment at the memory assessment service, please give details.
Who was the support provided by? E.g. GP, organisation like the Alzheimer’s Society etc.
Your answer
If you would have liked support in the time leading up to your appointment at the memory assessment service but weren’t able to access it, please give details.
Your answer
What support was useful or would have been useful in the time leading up to your appointment at the memory assessment service?
e.g. information about certain topics, someone to talk to about any fears or worries etc.
Your answer
Do you have any comments about the time leading up to your appointment at the memory assessment service?
Your answer
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