NEC Patient feedback

1. How we gauge your feedback

In order to provide the best possible experience for our patients and identify areas of improvement for our hospital, we value your feedback. We would appreciate you taking the time to complete this 1 minute survey. Your answers will remain confidential and be used solely to improve our services.

Please circle the number you feel best described your experience (1 being very poor and 5 being excellent).

Question Title

* 1. Please advise us of your admission date

Date

Question Title

* 2. Please select which procedural session you were in (AM or PM)

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* 3. Were you happy with the pre admission booking process and the instructions provided to you by the hospital staff?

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

Question Title

* 4. Were you happy with the admission process on the day?

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

Question Title

* 5. Were you happy with the care your received from the Nurses?

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

Question Title

* 6. Were you happy with the care your received from the Anaesthetist?

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

Question Title

* 7. Were you happy with the care your received from the Endoscopist?

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

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* 8. Were you happy with the cleanliness of the hospital?

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

1 (Very Poor)

2 (Poor)

3 (Average)

4 (Good)

5 (Excellent)

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* 9. Are there any additional comments you would like to add?

Question Title

* 10. Would you like someone to contact you regarding your answers? If so, please provide details

Name

Email Address

Contact Number