Page Updated 05/08/07

Feedback Survey

Website feedback questionnaire

Fields marked (*) are required

*Q1: Are you

Male

Female

*Q2: What is your age group?

17-24

25-40

41-49

50-59

60+

*Q3: What country do you live in?

*Q4: What is your ethnic background

White	Mixed
British	White and black Carribean
Irish	White and black African
Any other white background	Any other mixed background

Asian or Asian British	Black or Black British
Indian	Black Carribean
Pakistani	Black African
Bangladeshi	Any other Black background
Any other Asian background

Other
Chinese or Chinese British	Other ethnic or cultural group

*Q5: Are you a�.?

Other

Health professionals please go to question 10

Q6: If you are a patient are you receiving benefits for your condition ?

YES

Q7: If you are a patient please rate how well the information on the website helped you to explain your needs and symptoms to:

Health Professionals

Not applicable

Not at all helpful

Quite helpful

Very helpful

Family, Carers

Not applicable

Not at all helpful

Quite helpful

Very helpful

Employers

Not applicable

Not at all helpful

Quite helpful

Very helpful

Q8: If you are a patient how well has the information on the site helped you to manage your condition?

Not at all

Quite well

Well

Very well

Q9: If you are a patient how useful do you find the website overall ?

Not at all useful

Quite useful

Useful

Very useful

Q10: If you are a health professional how well has the information on the website helped you to assess the needs of your pelvic pain patients ?

Not at all well

Quite well

Well

Very well

Q11: If you are a health professional how do you rate the usefulness of the website overall ?

Not at all useful

Quite useful

Useful

Very useful

*Further comments