Short breaks consultation survey

Please read each of the following options for the short breaks consultation, we will ask you about each option at the end.

This survey will take 5 to 10 minutes to complete.

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Section 1: About You

Have you used any short breaks or emergency respite services in the last 12 months?

Yes

What is your relationship to short breaks services?

I am a person who uses the short breaks services / I have been assessed as someone who would benefit from using this service

I am a family member/unpaid carer for a person who uses (or has a need for) short breaks services

I am an advocate for a person who uses short breaks services

I am a young person/family member who will access adult short breaks or respite services in the future

I am a member of staff currently delivering the short breaks service

I am a member of the public

Other (please specify)

Section 2: About the service

Please rate how important or not the following aspects of the short breaks service are to you.

Having a location close to where I live

Use of familiar buildings and services

Choice of provider

Having consistency of staff

Having access to community activities