Vision Rehabilitation Services Questionnaire
Thank you for taking part in the questionnaire on rehabilitation services. The data you provide will be used to feed into a report on Vision Rehabilitation Services with the goal being to improve services provided to people living with sight loss.

Vision rehabilitation usually involves a worker from your local council or another organisation visiting you shortly after your diagnosis of sight loss to assess your needs and provide training and advice. The aim is to help people with sight loss to learn and develop the right skills to be able to get around safely and continue to do everyday activities, like preparing a hot drink or a meal and going to the shops.

This survey has been tested for accessibility, we recommend using Google Chrome to complete it if using the latest version of JAWS - or Internet Explorer if using an older version. If you would like any support with filling out the survey please contact Claire Bickley on 07814 767415 or email claire.bickley@pocklington-trust.org.uk

Any non-sensitive data you provide will be held for no more than 12 months. If you provide sensitive data such as name or email address, this will be held for 6 years in accordance with the General Data Protection Regulation (GDPR). A copy of the Thomas Pocklington Trust privacy policy can be accessed at the following link www.pocklington-trust.org.uk/privacy-policy/ if you have any questions or queries please get in touch.
1. Please select an age range from below. *
2. What is your gender? *
3. What is your postcode? *
Your answer
4. What is your eye condition? *
Your answer
5. Are you registered blind or partially sighted? *
6. Did you see an Eye Clinic Liaison Officer (ECLO) or similar sight loss advisor at the hospital, for information, advice and emotional support? *
7. How helpful did you find this support? *
Your answer
8. How did the sensory team at your local council first make contact? (If contact has not been made please use 'Other' to provide further details) *
9. How long did you have to wait before someone came out to see you? *
10. When did you receive support from a rehabilitation service provider? (An approximate date is fine) *
Your answer
11. What did the rehab worker discuss with you? Please select all that are relevant. *
Required
12. What pieces of equipment were you provided with? *
Required
13. Please give further details about your experience. *
Your answer
14. Have you had a follow up visit or phone call since you received support? *
Your answer
15. Do you feel more independent since you received support? *
Your answer
16. Do you feel an active part of your community? *
Your answer
17. Were you referred for other services? *
18. If yes, please provide further details.
Your answer
19. Any other comments?
Your answer
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