Adult Feedback Questionnaire

Autism Assessment

Adult Feedback
Questionnaire

We value your feedback. Please take a few minutes to share your experience with our service to help us improve the care we provide.

General Information

Patient’s age

Assessors names (if known)

Date of assessment

Assessment Process

How did you hear about our assessment services?

How would you rate the clarity of information provided before the assessment?

On a scale of 1 to 5, where 1 is very clear and 5 is very unclear.

12345

How would you rate the pre-assessment questionnaires?

On a scale of 1 to 5, where 1 is very clear and 5 is very unclear.

12345

Was the appointments process convenient for you?

YesNo (please explain)

Assessment Experience - History Taking Appointment (ADI-R)

Have you had a History Taking Appointment (ADI-R)?

YesNo

Do you think the assessment process was thorough and comprehensive?

YesNo (please specify)

Were your concerns and questions answered during the assessment?

YesNo (please specify)

Did you feel involved and informed throughout the process?

YesNo (please specify)

Was the assessment environment comfortable and child-friendly?

YesNo (please specify)

Assessment Experience - Observation Appointment (ADOS)

Have you had an Observation Appointment (ADOS)?

YesNo

Do you think the assessment process was thorough and comprehensive?

YesNo (please specify)

Were your concerns and questions answered during the assessment?

YesNo (please specify)

Did you feel involved and informed throughout the process?

YesNo (please specify)

Was the assessment environment comfortable and child-friendly?

YesNo (please specify)

Post Assessment Support

How would you rate the clarity of the assessment report and recommendations?

On a scale of 1 to 5, where 1 is very clear and 5 is very unclear.

12345

Were you provided with adequate resources and guidance for the next steps?

YesNo (please specify)

Do you feel better equipped to support your child after the assessment?

YesNo (please specify)

Overall Experience

What did you find most helpful about the assessment process?

What improvements would you suggest?

Would you recommend our assessment services to other families? Please explain why or why not?

Thank you!

Thank you for your feedback. Your experience matters and helps us improve our care.

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0333 004 7700

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