AFTER ATOS ASSESSMENT

Form Login Account (optional)

New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form.

CUSTOMER FEEDBACK SURVEY

Since 2008 Atos has assessed 100,000s disabled people to see if they are fit for work and get them off benefits. From April 2011 Atos seeks to assess over 10,000 disabled people per week. No one knows what happened to the 100,000s disabled who were assessed before and no one will know what happens to the disabled who will be assessed in future unless those assessed tell it for themselves. After Atos Assessment form provides that very opportunity. Thank you for your contribution.

Advice on filling in form:
Please take your time and read through the form first making note of the questions which just need clicking and short answers and those which ask for more indepth and personal answers. It can be very tiring and emotional going through the form as it brings back memories and stress. So go through the form but don't fill it in. As can only fill it in and send it once. Make a note of the ones which ask for indepth experience and write it separately in "word" or other office application. Add it when you are ready. You can close the form by coming out of it. As long as you have not sent it it has not been processed. When you are ready open up the form again and copy and paste your written answers in. This will give you time and stop you feeling you have to fill it in all at once. Take your time, look after yourself, it is you that is important. (Admin)

Have you had the
ESA Medical Assessment? *

Yes

No

Did not have to have assessment. Decision made without my attendance

Date of Assessment

What was the result? *

Not fit for work

Fit for work

Tick if client has since died

Choice A

Who is filling in this form? *

If someone else is filling in form; Who? and Why?

Name or Name you would like to use for this survey. 🛈

Town/City * 🛈

County *

Email address 🛈

Name of Assessor 🛈

Qualification of Assessor

Where Assessment Took Place? *

TELL US ABOUT YOUR DISABILITY
Give Official Medical Diagnosis, the official nature and affects of the condition then how it affects you personally. There is no word limit. However, try and be brief, orderly and factural under headings such as Physical - pain, mobility, loss and dysfunction of organs and bodily system, perceived outcome (improve, remain same, deterioration, terminal); Mental - how it affects your thinking and mental functioning, Emotions how it affects how you feel, social - being able to get out and mix and be with others. Use and refer to already existing informed knowledge of your condition as well as your own personal experience. If possible include links to sites explaining your condition. This is your opportunity to voice and record your experience.

What type are your disabilities? (You can tick more than one)

1st Diagnosis *

2nd Diagnosis

3rd Diagnosis

Is your condition

Tell Us of Further Diagnosis and Conditions

Tell Us About the Assessment

How accessible was the centre? *

	None at all	Very Bad	Bad	Don't Know	Not Applicable	Acceptable	Good	Very Good	Excellent
For Disabled Parking	None at all	Very Bad	Bad	Don't Know	Not Applicable	Acceptable	Good	Very Good	Excellent
Disabled Access into Building	None at all	Very Bad	Bad	Don't Know	Not Applicable	Acceptable	Good	Very Good	Excellent
Disabled Access inside the Building	None at all	Very Bad	Bad	Don't Know	Not Applicable	Acceptable	Good	Very Good	Excellent
Suitability of Interview Room	None at all	Very Bad	Bad	Don't Know	Not Applicable	Acceptable	Good	Very Good	Excellent

Explain Further and Give More Details

Did you provide additional supporting evidence from others? *

Yes

No

If Yes from whom and what did it say? (Do not need all of it. Just say if it confirmed and supported your condition and diagnosis, its difficulties etc)

Tell Us About the Assessment and Assessor *

	Very Bad	Bad	Don't Know	Not Applicable	Acceptable	Good	Very Good
How was the assessors attitude and behaviour towards you?	Very Bad	Bad	Don't Know	Not Applicable	Acceptable	Good	Very Good
How did the assessor communicate and engage with you?	Very Bad	Bad	Don't Know	Not Applicable	Acceptable	Good	Very Good
How was the assessor's knowledge and understanding of your condition?	Very Bad	Bad	Don't Know	Not Applicable	Acceptable	Good	Very Good
How did the assessment adequately investigate and reflect your condition?	Very Bad	Bad	Don't Know	Not Applicable	Acceptable	Good	Very Good

Please Explain and Give More Details

Outcome and Consequences

How has Atos Assessment and Decision Affected you? *

	Greatly Worsened	Slightly Worse	Stayed Same	Don't Know	Slightly Improved	Greatly Improved
Finances	Greatly Worsened	Slightly Worse	Stayed Same	Don't Know	Slightly Improved	Greatly Improved
Care/Support	Greatly Worsened	Slightly Worse	Stayed Same	Don't Know	Slightly Improved	Greatly Improved
Physical Health	Greatly Worsened	Slightly Worse	Stayed Same	Don't Know	Slightly Improved	Greatly Improved
Mental Health	Greatly Worsened	Slightly Worse	Stayed Same	Don't Know	Slightly Improved	Greatly Improved
Family/Social life	Greatly Worsened	Slightly Worse	Stayed Same	Don't Know	Slightly Improved	Greatly Improved
Work Life	Greatly Worsened	Slightly Worse	Stayed Same	Don't Know	Slightly Improved	Greatly Improved

Please Explain and Give More Details

Have you officially informed Atos of your experience?

Yes

No

Not yet Still thinking of doing

Have you informed anyone else? If so who?

Have you made an appeal?

Yes

No

Not Yet

If not, why have you not appealed?

Have you won an appeal?

Yes

No

Still waiting

What has happened since?

What did you think of this questionaire? Please leave feedback.

THANK YOU FOR YOUR TIME AND CONTRIBUTION
The results will eventually be published on line and aim to provide
a monthly rolling evaluation and assessmentas to how Atos is
positively or negatively affecting the disabled their lives

All information is confidential. No personal details or personal testimonies will be used, shown or passed on to any third party without your permission and involvement. However, would you be interested in sharing or having your testimony used as an example if press, media or other interested and infuential bodies were interested? *

No. I would not like to share my personal details and witness

Yes. I would be prepared to share my personal details and testimony

Don't Know. May decide later. (You can always contact us at a later date)

Physical	Mental Health
Learning Difficulties	Severe Learning Difficulties
Multi-complex condition	Drugs/Alcohol
Behavioural Problems (Torrettes/Self Harm/Challenging Behaviour etc)