The Women’s and Children’s Health Network is committed to ensuring that children, young people and women receive quality health care services that are focused on a Person and Family-Centred Care approach:

> Treat consumers and their family with dignity and respect
> Communicate information clearly and openly with the consumer
> actively involve consumers in decision making
> Be positive and kind.

We invite you to complete this feedback form. Your responses will be anonymous. Your feedback will help us improve how we deliver (insert expected outcomes). As such, all personal information will be kept confidential and private. All information gathered from the survey will be de-identified.  As such, the de-identified information might be used in the project report, presentations at conferences and training material.  Furthermore by providing feedback on services provided by the WCHN we are committed to ensuring that your individual or families current or future treatment will not be affected if you choose to or withdraw from providing feedback.  If your feedback is urgent you can speak to the manager of the service area or you can email HealthWCHNConsumerFeedback@sa.gov.au or 8161 6710. 
Please note that due to the nature of the Internet, it is possible that data transmitted online can sometimes be accessed by unauthorised third parties as with any online information.  While every effort is made to minimise this risk, we cannot guarantee that the information you provide online will never be compromised.  Once the data is retrieved from the survey software provider it will be securely stored on password protected computers and password protected electronic files which will be accessed by the Manager of Consumer and Community Engagement. This survey is using SurveyMonkey to collect the data. Data collected via SurveyMonkey is held in the United States.  You can access SurveyMonkey’s terms of use here. Women’s and Children’s Health Network will  hold the data for a 12 month period.  This project has been approved by the Women’s and Children’s Health Network Human Resource Ethics Committee. If you wish to discuss the approval process, or have any concerns or complaints about the project you can contact the Executive Officer of the WCHN HREC, Luke Fraser on 8161 6521.

SOME INFORMATION ABOUT YOU.

* 1. What division are you from? (if known)

* 2. Which ward, unit or service are you answering these questions from?

* 3. Do you identify as

* 4. Do you identify as a person with 

* 5. What is your age?

LETS GET STARTED ON THE 5 QUESTIONS

* 6. Did you receive information on your healthcare rights and responsibilities?

* 7. How often...

  Always Most of the time Sometimes Never
were you treated with dignity and respect?
did staff listen to you carefully?
understand what was going on for you?
did you make decisions about your or your child/young person's healthcare?
that your healthcare rights were upheld?

* 8. How often...

  Always Most of the time Sometimes Never Not Applicable
my cultural needs met?
spiritual or religious needs met?

* 9. Please feel free to comment or give us a little information about your selection above.

* 10. Overall how would you rate the care you were given?

THANK YOU.  ONE LAST QUESTION.

* 11. How could the healthcare service be improved for next time or do you have any ideas to advance the comfort for consumers accessing the Women's and Children's Health Network?

* 12. Please leave your name and email; if you give permission to find out more about being a Consumer Representative.

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