Patient Feedback Form

Patient Feedback

We value your feedback to assist us to improve the service that we provide to our patients

We ask for your help by completing this short 9 question survey relating to your recent treatment. We welcome your additional comments.

At my initial consultation and anaesthetic assessment appointment, my views were listened to and my needs were met: *

Strongly agreeAgreeUnsureDisagree

I was involved as much as I wanted to in making decisions about my treatment and care: *

Strongly agreeAgreeUnsureDisagree

I was provided with adequate information, both verbally and written, about my treatment and care: *

Strongly agreeAgreeUnsureDisagree

How would you describe the welcoming by the registered nurse? *

ExcellentGoodAverageBelow Average

As far as I could tell, the staff involved in my care communicated with each other about my care and treatment: *

Strongly agreeAgreeUnsureDisagree

How would you describe the care you received during your recovery *

ExcellentGoodAverageBelow Average

I felt confident in the safety of my treatment and care: *

Strongly agreeAgreeUnsureDisagree

Overall, the quality of care and treatment I received: *

Exceeded my expectationsMet my expectationsWas below my expectations

Would you recommend us to others? *

YesMaybeNo

If you selected Unsure, Disagree, Average or Below Average to any of the above, please provide further information

Is there anything else you would like us to know?

Name (Optional)

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