Quality of Care Questionnaire

General Questions

Question Title

* 1. Your room number

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* 2. Date your baby was born

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* 3. Date of discharge

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* 4. How many days were you in hospital after your baby was born?

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* 5. Would you like the manager to call you to discuss your concerns

yes

no

Please email if you would like an opportunity for family care participation

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* 6. Your name, address and telephone number

Name:

Address 1:

City/Town:

State/Province:

ZIP/Postal Code:

Country:

Email Address:

Phone Number:

Please feel free to email felicia.giordanella@sunnybrook.ca with any concerns or suggestions