Waiting List Experience Survey

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* 1. Are you, your child, or a relative on a HSE waiting list, or have you been?

Yes - currently on a list

Yes - previously on a list

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* 2. Do you have private health insurance?

Yes

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* 3. What sort of list are you/your child/relative on?

To see a consultant

To have a procedure

An assessment of need (for disability/education services)

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* 4. Please specify specialty, condition, and procedure as appropriate

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* 5. How long have you/your child/relative been on a waiting list?

0-3 Months

3-6 Months

6-12 Month

12-18 Months

18+ Months

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* 6. How has the length of wait affected you/your child/your relative's condition?

Severe

Considerable

Moderate

A little

Not at all

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* 7. How has the length of wait affected you/your child/your relative's general and mental health?

Severe

Considerable

Moderate

A little

Not at all

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* 8. In what way has it impacted on you/your child/relative's condition, health, and wellbeing?

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* 9. How has this experience impacted on your family?

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* 10. Please tick the options which apply to you

This has impacted negatively on my quality of life

This causes me a lot of stress or anxiety

This causes me some stress or anxiety

It does not concern me

I have considered private healthcare, but I am worried about the cost

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* 11. Do you believe that the Government is doing enough to tackle waiting lists?

Yes

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* 12. Do you have any comment you would like to add?

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* 13. Demographic question - If this is about you/your child, what is your household income?

Cannot work due to condition

Under €15,000

Between €15,000 and €29,999

Between €30,000 and €49,999

Between €50,000 and €74,999

Between €75,000 and €99,999

Between €100,000 and €150,000

Over €150,000

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* 14. Demographic question - what is you/your child/your relative's age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Waiting List Experience Survey

Question Title

* 1. Are you, your child, or a relative on a HSE waiting list, or have you been?

Question Title

* 2. Do you have private health insurance?

Question Title

* 3. What sort of list are you/your child/relative on?

Question Title

* 4. Please specify specialty, condition, and procedure as appropriate

Question Title

* 5. How long have you/your child/relative been on a waiting list?

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* 6. How has the length of wait affected you/your child/your relative's condition?

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* 7. How has the length of wait affected you/your child/your relative's general and mental health?

Question Title

* 8. In what way has it impacted on you/your child/relative's condition, health, and wellbeing?

Question Title

* 9. How has this experience impacted on your family?

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* 10. Please tick the options which apply to you

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* 11. Do you believe that the Government is doing enough to tackle waiting lists?

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* 12. Do you have any comment you would like to add?

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* 13. Demographic question - If this is about you/your child, what is your household income?

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* 14. Demographic question - what is you/your child/your relative's age?

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* 15. Demographic question - what county are you living in?