Eye Clinic Liaison Officer (ECLO) Service Questionnaire
Currently in Birmingham there are a number of hospitals that provide eye clinic services and only 2 Eye Clinic Liaison Officers (ECLOs).

An ECLO provides emotional and practical support to patients who have recently lost their sight and their families. When losing sight it can be a very traumatic experience and navigating your way through a new world of sight loss can be very difficult. An ECLO can make this process much easier.

We want to hear from patients and their families on the difficulties they have faced as we campaign to bring more ECLO support into our regions hospitals.

Please complete our short survey below it should not take any longer than 5 minutes

This survey has been tested for accessibility in Internet Explorer, we recommend using this browser to complete it. 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. How old were you or your family member when you/they lost your/their sight?
2. Which hospital did you attend?
3. Did you see an ECLO?
4. If yes, how helpful did you find the support?
Your answer
5. If no, what support were you offered from the hospital staff?
Your answer
6. Do you know what a certificate of vision impairment (CVI) is, and were you told what would happen with it?
Your answer
7. Were you referred for support from our local authority (possibly through the Certificate of Visual Impairment process) and if so, how long did you have to wait for support?
Your answer
8. Were you referred to any local sight loss charities for additional support?
Your answer
9. Please use the below box to give detail about your journey since losing your sight and any difficulties you have faced?
Your answer
The Birmingham Sight Loss Council seeks to campaign for change for people living with sight loss locally. If you would like to know more about what we do and maybe get involved, please leave your contact details below.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service