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* 1. Did you come to Zithulele Hospital as a:

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* 2. What is your age and gender?

  Male Female
younger than 20 years
20-40 years
41-60 years
older than 60 years

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* 3. Which part/s of the hospital did you receive attention in?

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* 4. How caring were the staff who helped you?

  Very rude Uncaring Not caring or uncaring Caring Very caring
Doctors
Clinical staff (therapy, pharmacy etc, not doctors)
Nurses
Administration staff

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* 5. Please helps us improve waiting times (remembering the context)

  Strongly disagree Disagree Not sure / Neutral Agree Strongly agree N/A
There was a bench for me to sit on while I waited
I had to wait a long time to see the clerks (and get a stamp or folder)
The person who gave me my folder was helpful
The out-patients department has convenient opening hours
I had to wait a long time to get an X-ray
I had to wait a long time to see a doctor or therapist
I had to wait a long time at the pharmacy

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* 6. Did we meet our obligations to you?

  Strongly disagree Disagree Not sure / Neutral Agree Strongly agree
I felt safe at the hospital
The nurses here are caring towards the patients
The nurse who treated me listened to my problems
The doctor who treated me was polite
The doctor clearly explained about my condition and treatment
The staff at the hospital answered all my questions about my illness
When I needed help at night there was always a nurse to help me
My privacy was respected by all the staff

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* 7. How clean was the hospital?

  Strongly disagree Disagree Not sure / Neutral Agree Strongly agree
The hospital was clean
The toilets were dirty
The ward was clean
The bedding (linen) was clean

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* 8. Was the medicine the doctor prescribed available at the pharmacy?

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* 9. Province would also like us to ask you these few questions

  Strongly disagree Disagree Not sure / Neutral Agree Strongly agree N/A
It costs more than R7 to get to the hospital
The food was good
Visiting hours were not long enough
I was very bored at the hospital
The hospital will tell my local clinic about my future health care needs

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* 10. Overall, how would you rate your experience at Zithulele Hospital

  Strongly disagree Disagree Note sure / Neutral Agree Strongly agree
The hospital is in good condition
I was pleased with the way I was treated at the hospital
Next time I am ill I will come back here
If my friends are sick I will tell them to come to this hospital

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