Patient & Family Experience Survey

33% of survey complete.
Thank you for taking the time to complete our Patient & Family Experience Survey. 

Your feedback provides us with valuable information that can help to identify areas for improvement, so that we may continue to provide exceptional care to our patients and family members.

All responses collected will be kept private and confidential and are only used for internal quality improvement purposes.

Hospitals are committed to accessibility for persons with disabilities. Upon individual request, a patient or family member that requires accommodation to provide feedback is advised to contact the Patient Relations/Patient Experience office of the Hospital you visited.

* 1. Person completing survey

* 2. If you declined, would you like to have this survey emailed for completion at your convenience?

* 3. Date of your experience:

* 4. Type of Feedback

* 5. During your stay, were you provided with a Patient & Family Handbook

* 6. Did you find the information provided in the Patient & Family Handbook Helpful

* 7. What Hospital did you visit:

* 8. My Experience was in:

* 9. During my experience:

  Strongly Agree Agree Disagree Strongly Disagree Not Applicable
I was treated with courtesy and respect
My concerns were considered important
There was enough done to address my pain/discomfort
Things were explained to me in a way I could understand
My questions were answered to my satisfaction
My whiteboard was helpful in keeping my family and I informed
My family and I felt included in planning my care
My fears / anxieties were addressed
My call bell was answered in a reasonable amount of time
Staff ensured my stay was as restful as possible
The environment was kept clean and free of clutter
It was easy to get into my room and washrooms
I was served quality food
Food was served by caring staff
My needs were attended to in a timely manner
All staff were sensitive to my cultural values and those of my family or caregiver (e.g., language, religious beliefs, ethnic/racial background)
I observed my care providers sanitizing/washing their hands

* 10. As I prepare to leave the hospital:

  Strongly Agree Agree Disagree Strongly Disagree Not Applicable
I am aware of and understand my discharge plans
I am aware of all required follow up medical appointments and treatments
I know who to call if I have any questions or concerns

* 11. Rate your overall experience

* 12. Do you have any suggestions that could improve the accessibility of our hospital and services for people with disabilities?

* 13. Is there a staff member, physician or volunteer that you would like to recognize for providing exceptional care?

* 14. Would you recommend this hospital or department to your family and friends?

* 15. Do you have any suggestions that may have improved your experience?

* 16. Do you wish to have someone contact you to discuss your experience?

* 17. Would you be interested in volunteering for any future healthcare improvement work?

* 18. If you are completing this survey from bedside, we would like just a few more minutes of your time to gather your feedback on our new patient experience feedback process using the iPads. Please take a moment to answer the following questions.

  Yes No
Were the survey questions relevant to your hospital stay?
Were the survey questions easy to understand?
Were you comfortable completing the survey on the iPad?
Did you require the assistance of the volunteer to help you complete the survey?
Did you find it helpful to complete the survey before you went home?
If you have any further questions or concerns please do not hesitate to contact our Patient Experience Office:

Telephone:  519-272-8210 Ext. 2737
Mailing Address:
46 General Hospital Drive
Stratford, ON   N5A 2Y6
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