Memory Assessment Service - Questionnaire for patients
The Health Scrutiny Committee of Lancashire County Council is undertaking a review of the services, advice,
guidance and support that is available designed for people diagnosed with dementia. The review is being carried out
by a panel of councillors and they would like to receive the views and comments of service users.
Therefore if you or a relative has ever used the memory assessment service please complete the brief questionnaire
below. We are not asking for any personal information but if you would like to have the opportunity to discuss your
comments further with the review panel please provide your name and contact details.
Q1 What prompted you to attend a memory assessment clinic?
Q2 Who made the appointment? You
(please tick relevant box)
Other (please state)
Q3 What happened during your first visit to the clinic?
Q4a What information did you receive and did you find it useful?
Q4b Did you feel reassured?
Q5 What did you find good about the experience?
Q6 What did you find bad about the experience?
Q7 In your opinion, how could the service be improved?
Q7a Would you recommend the service to others?
Q8a What changes, if any, have you made to your life since the visit to the memory assessment
Q9 Was any physical or mental activity advised?
Q10 What was the location of the memory assessment clinic that you attended?
If you are happy for a member of the review panel to contact you to discuss your comments further please complete
the box below. Once again thank you for your help in this review.
Please return to: Wendy.firstname.lastname@example.org