Survey – DAA

The B&NES DAA are undertaking a research project. We are working to make B&NES a dementia-friendly community that will understand and help people living with dementia and their carers.

We want to find out what people with memory problems do in your area, what facilities they use and what helps or hinders them. We want to find out more about what makes places easier to live in for people with memory problems. Please participate by clicking the link attached.

About You

If you consent to completing this survey please tick this box *

Please give your age in years *

Please give your gender *

Please state the area of B&NES you live in *

Tick the box that applies to you:

I am a person with dementia or memory problems

I am a carer or friend of a person with dementia or memory problems and I am filling in this questionnaire on their behalf.

I work with people with dementia or memory problems and I am filling in this form on their behalf.

None of the above

What makes it more difficult for you to do these things?

Are there things you used to do but have stopped doing? e.g. shopping, going to the hairdressers/barbers, social events.

If so, why have you stopped doing them?

What might help you to start doing them again?

Are there new things that you would like to be able to do in your community?

If so, what do you feel is stopping you?

What might help you to start doing them?

Have you seen the B&NES Guide to Services for People with Dementia? If yes, where did you get it?

Do you use the Internet? If yes, what websites do you use?

Finally, what do you think could be done to make your community more dementia-friendly?

You have reached the end of the questionnaire. Thank you for your help. The answers you have given us will help us to work out what needs to be done to make B&NES dementia-friendly. If you would like to find out more about making B&NES a dementia friendly community please write down your contact details below and we will add you to our mailing list:

Name

Telephone Number

The B&NES DAA are undertaking a research project. We are working to make B&NES a dementia-friendly community that will understand and help people living with dementia and their carers.

About You

Tick the box that applies to you:

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