Within Outpatient services we are continually seeking to improve the care we offer. The views of our patients are of utmost importance to use in finding out what improvements we need to make.

Please take a few minutes to complete this questionnaire and tell us about your experience today.

All responses are anonymous. If you require any assistance in completing the questionnaire please ask a member of staff. When you have completed the questionnaire, place in the identified box.

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* 1. Have you ever visited this outpatients department before?

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* 2. Before your appointment, were you…

  Yes No
Given a choice of appointment times?
Was your appointment changed to a later date by the hospital?
Given a number to contact if you had any questions?
Told that you could bring a significant other to your appointment?
Given adequate information on how to find the department?
Given adequate information on car parking facilities?

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* 3. On arriving at your appointment, were you...

  Yes No
Able to find the department easily?
Greeted courteously?

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* 4. Were you told how long you would have to wait?

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* 5. How long after the stated appointment time did the appointment start?

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* 6. Who did you see?

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* 7. In your appointment, did the staff...

  Yes No
Introduce themselves to you?
Explain what would happen in the assessment / treatment?
Did you have enough time to discuss your health or medical problem with the doctor?
Explain the risks and / or benefits of the treatment in a way that you could understand?
Listen to and appreciated your concerns and needs?
Inform you what the next stage of your treatment would be?
Did you have confidence and trust in the doctor / nurse examining and treating you?

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* 8. After your appointment...

  Yes No
Did you require a further appointment?
Were the reception staff clear in explaining when this would be?
Did you leave with this appointment?
If not, what did the staff inform you?
Were you satisfied with the information received?

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* 9. Overall, in your appointment, were you...

  Yes No
Allowed enough time to discuss your concerns and needs?
Did you feel involved as much as you wanted to be in decisions about your care and treatment?
Given enough privacy when discussing your condition and treatment?
Treated with respect and dignity?
Did you witness our staff washing / applying alcohol gel to their hands?

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* 10. Was the main reason you went to the outpatients department dealt with to your satisfaction?

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* 11. Would you recommend this service to friends and family if they needed similar care or treatment?

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* 12. Overall, how would you rate the care you received at this appointment?

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* 13. Comments/ Is there anything we could do differently?:

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