CHD wellbeing and lifestyle questionnaire

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Together with the clinical teams across the region the Network are reviewing the support provided to CHD patients and families. This will look in to all aspects of support provided to patients and families, either in or out of hospital, for the life course of your congenital heart disease.

We would like to hear from you about your experiences of living with CHD. How has your experience made you feel? What additional support do you and your family need? Take part in out survey to tell us more.

Are you ....?

Patient
Parent
Carer
Sibling
Grandparent
Other:

Have you experienced any of the following?

Depression
Anxiety
Stress
Social isolation
Post-traumatic stress disorder
Altered ability to perform in education/job
Other:

Please tick any words to describe feelings you have experienced

Overwhelmed
Anxious
Depressed
Worried
Scared
Out of control
Uncertainty
Fear
Hopelessness
Alone
Stigmatised
Negative
Other:

Please choose services that you would look to for support

Self-care
Peer support
Support groups
Psychologist
Support worker
Well-being practitioner
GP
Specialist nurse
Family
Other:

When would you look to access support?

Before hospital admission
At diagnosis
During hospital admission
After discharge
After traumatic event
Managing life events
Deterioration in condition
Other:

Please use the box below if you have any suggestions or wish to share anything further.

If you would like to get in touch please email us at nuth.enquiries-nencchdn@nhs.net or use the contact page on our website https://nenc-chdnetwork.nhs.uk/contact-us.

All information is held in the strictest confidence.

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