collaboRATE Form

Thank you for agreeing to complete this questionnaire

There are three questions. Please circle one number only between 0 – 4 that reflects how you feel.  

• 0 means you felt no effort was made.
• 1 means you felt a little effort was made
• 2 means you felt some effort was made
• 3 means you felt a lot of effort was made
• 4 means you felt every effort was made. 

Please try and answer all three questions. Each question has space to explain the number you have given. This is optional but will help us understand what is working well and what could be improved

For more information on why your feedback has been requested, see the Information sheet.

Thinking about the care you have received for your long term conditions